This document outlines a 6 stage algorithm for managing patients with decreased consciousness. The stages are: 1) ABCD assessment, 2) ensuring proper airway and breathing with tubes if needed, 3) asking for help, 4) monitoring the patient, 5) taking a medical history, and 6) performing a full physical examination checking various body systems. The goal is to identify potential causes of decreased consciousness such as head injury, infection, drug overdose, or medical conditions and provide appropriate treatment.

1. Algorithm for managing patient
with decreased conscious level
By
Dr. Khaled Osama Abo-sha3era
Lecturer of neurology
Assiut University Hospoital

2. 6 Stations
• ABCD
• Tubes
• Ask for
• Monitor
• History
• Examination

3. Stage 1: ABCD

4. Stage 2: Tubes
• Airway obstructs if not supported
• Airway compromised by vomiting
• Resp rate inadequate for ventilation
• 02 sat. <92% despite high flow O2

5. Stage 3: Ask for

6. Stage 4: Monitor

7. Stage 5: History
Headache, Vomiting, Fever, Convulsions,
Fluctuation of consciousness, Medical condition,
Recent insufficient oral intake, Heat exposure
Chest pain, Difficulty of breathing, Bleeding
Drug intake, Toxic exposure, Trauma

8. Stage 6: Examination
Head: Pallor, Jaundice, Cyanosis, Pupil reaction & equality,
Mouth deviation, tongue bite
Neck: CVP, suprasternal indrowing or pulsation, Neck stiffness
Chest: Movement, Indrowing, Dullness, Air entry, Rhonchi,
Crepitation
Heart: Pulsation, Arrhythmia
Abdomen: Liver, Spleen, Ascitis, Urine retention
Limbs: Pulse, Edema, Ecchymosis, Rash, Meningeal signs

9. Thank you