1) Level of consciousness refers to how responsive a person is to external stimuli and can be altered due to structural issues like trauma or tumors, metabolic derangements like hypoglycemia, or infections in the brain. 2) The Glasgow Coma Scale is used to objectively measure a person's level of consciousness on a scale of 3 to 15 to determine the severity of a brain injury. 3) Investigations like blood tests, imaging studies, and monitoring of vital signs are used to identify potential medical causes of an altered level of consciousness in order to guide management and resuscitation.

1. LEVEL OF CONSCIOUSNESS
Recognition and Management
By GBONEME S.E

2. OUTLINE
• INTRODUCTION
• DEFINITION OF TERMS
• AEITIOLOGY
• PATHOPHYSIOLOGY
• GLASGOW COMA SCORE
• INVESTIGATION
• MANAGMENT

3. INTRODUCTION
Content
Arousal
Consciousness

4. INTRODUCTION Contd
• Level of consciousness (LOC) is a measurement of
a person's arousability and responsiveness to
stimuli from the environment.
• Altered consciousness is one of the most
common findings encountered by a
neurosurgeon.
• Altered level of consciousness is a condition of
being less responsive to and aware of external
stimuli

5. Definition of Terms
• CONFUSED: disoriented to surroundings, may have impaired
judgment, may need cues to respond to commands.
• LETHARGIC: Drowsy, needs gentle verbal or touch stimulation to initiate
response.
• OBTUNDED: responds slowly to external stimulation and needs
repeated stimulation to maintain attention and response
• STUPOROUS: responds only minimally with vigorous stimulation,
may only moan as a verbal response
• COMATOSE: no observable response to any external stimuli

6. AEITIOLOGY
• Structural
Trauma: cerebral edema, subdural and epidural
hematoma.
Vascular: subarachnoid hemorrhage, infarction.
Infection: meningitis, encephalitis, brain abscess.
Neoplasms: metastatic tumor, primary brain tumor

7. AEITIOLOGY Contd:
• Metabolic:
Toxicity: drugs (opiates), heavy metals, carbon monoxide
Systemic metabolic derangement: hypoglycemia,
hyponatremia, diabetic ketoacidosis, hyperglycemia
Extremities of body temperature: Heat stroke,
hypothermia
Hypoxic encephalopathy: severe anemia, severe
pulmonary disease, severe heart failure.

8. PATHOPHYSIOLOGY
• Cellular brain edema or a disrupted chemical
transmission at the receptor site results in
faulty impulse transmission and impending
communication within the brain or from the
brain to other body parts.

9. Glasgow Coma Scale
• Glasgow Coma Scale (GCS) is
a neurological scale which aims to give a
reliable and objective way of recording the
conscious state of a person for initial as well as
subsequent assessment.
• It is also useful in the classification of head
injury

14. CONTD:
• A patient is assessed against the criteria of the
scale, and the resulting points give a patient
score between 3 (indicating deep
unconsciousness) and 15.
• A score of 15/15 with no LOC – Mild head injury
• 14/15 or15/15 with LOC – Minor head injury
• 9 -13/15 – Moderate head Injury
• 3-8/15 – Severe head injury

15. PHYSICAL EXAMINATION

16. INVESTIGATIONS
• Complete blood count ( Rule out severe anemia
evidenced by low RBC’S, decreased PCV. Also, infection,
evidenced by elevated WBC’s and differentials).
• Blood Glucose ( Rule out Hypo/Hyper glycaemia)
• Electrolytes/ Urea/ Creatinine (Rule out electrolyte
derangement as well as uremic encephalopathy)
• Imaging Studies:
• X-ray
• CT-SCAN
• MRI

17. RESUCUITATION
• The A..B..C..D’s
• A- Airway:
• Stabilize Neck
• Ensure Airway is patent
• Suction if necessary
• Use of Airway adjunct.
• Use of endotracheal tube if indicated
• B- Breathing;
• Use of mechanical ventilator is used to maintain adequate oxygenation

18. CONTD
• Circulation
• Monitor circulatory status using the following parameters.
Blood pressure, heart rate. Ensure adequate perfusion to
body and brain.
• Pass an intravenous catheter to provide fluid access
• Give adequate intravenous medications
• Determine and treat the underlying cause of the LOC