Unconsciousness is an abnormal state where the patient is unaware of their surroundings and can range from momentary to lasting months. It can be caused by structural brain lesions, metabolic disorders, or psychogenic factors. Management involves following ABCs - airway, breathing, circulation, giving oxygen, IV access, stabilizing the cervical spine, checking blood glucose, controlling seizures, and considering IV treatments like glucose, thiamine, naloxone or flumazenil. Further examination, history, and diagnostic tests are needed to investigate the underlying cause and plan additional treatment.

1. UNCONSCIOUSNESS

2. UNCONSCIOUSNESS
IT IS AN ABNORMAL STATE RESULTING FROM
DISTURBANCE OF SENSORY PERCEPTION TO
THE EXTENT THAT THE PATIENT IS NOT AWARE
OF WHAT IS HAPPENING AROUND HIM.
PERIOD MAY BE MOMENTARY OR MAY LAST FOR
MONTH.

3. LEVELS OF UNCONSCIOUNESS
• EXCITATORY UNCONSCIOUSNESS:
 PATIENT DOES NOT RESPOND COHERENTLY
BUT IS EASILY DISTURBED BY SENSORY
STIMULI.
 COMMONLY SEEN IN PATIENTS WHO ARE
GOING UNDER ANESTHESIA.

4. • SOMNOLENT:
PATIENT IS EXTREMELY DROWSY AND
WILL RESPOND ONLY OF SPOKEN TO
DIRECTLY AND PERHAPS TOUCHED.

5. • STUPOROUS
PATIENT RESPONDS ONLY TO PAINFUL
STIMULI SUCH AS PRICKING OR
PINCHING OF THE SKIN.
IN DEEP STUPOR PATIENT MAY RESPOND
ONLY TO SUPRAORBITAL OR SUBSTERNAL
PRESSURE.

6. ETIOLOGY
• STRUCTURAL LESIONS IN BRAIN.
eg; Brain tumor,Cerebral haemorrage.
• METABOLIC DISORDERS.
eg;Infections,Hypoglycemia,Nutritional
deficency.
• PSYCHOGENIC CAUSES.
eg;Hysteria, Catatonia.

7. PATHOPHYSIOLOGY
HYPOXIA
ISCHEMIA
CHEMICALS NEEDED TO
CARRYOUT FUNCTION NOT
FORMED
COMA
DIRECT
COMPRESSI
ON IN
BRAIN
STEM TOXIC WASTE
FROM
LIVER/KIDNEY
ECT..

8. CLINICAL MANIFESTATIONS
MANIFESTATION METABOLIC
INDUCED
STRUCTURALLY
INDUCED
HISTORY BEHAVIOURAL
CHANGE
LOCAL
SEIZURE,HEADACHE
TYPICAL PROBLEM HEPATIC COMA,DKA TUMOR,BLEEDING
PUPILLARY
REACTION
PRESERVED UNEQUAL
REACTION
PUPILLARY SIZE MID POSITION AND
FIXED
PINPOINT
CORNEAL REFLEX PRESENT ABSENT
EXTRAOCCULAR
MOVEMENT
DOLL’S EYE ABSENT GAZE PARESIS
EXTREMITY
MOVEMENT
MOVES BOTH SIDES WEAKNESS
REFLEXES PRESENT UNEQUAL
RESPONSE TO PAIN EQUAL UNEQUAL

9. DIAGNOSTIC ASSESSMENT
• GLASGOW COMA SCALE.
• COMPUTED TOMOGRAPHY.
• MAGNETIC RESONANCE IMAGING.
• LUMBAR PUNCTURE.
• EEG.
• VENTRICULOGRAPHY.
• ANGIOGRAPHY.
• DRUG LEVEL.
• LFT/RFT

10. • BLOOD GASESW & PH
• SERUM GLUCOSE,CALCIUM,SODIUM ect.

11. MANAGEMENT
• ABC
• Immediate management
• Examination
• History
• Investigations

12. ABC
B-
BREATHIN
G
C-CIRCULATION
A-AIRWAY

13. Immediate management
• Maintain i.v line, oxygen inhalation
• Blood sample for RBS
• Control seizures
• Consider i.v glucose, thiamine, naloxone,
flumazenil

14. Nursing Management
• Maintenance of an adequate airway.
• Maintenance of circulatoin.
• Moving and position.
• Mouth care.
• Eye care.
• Food and fluids.
• Prevention of accidents.

15. SUMMARY
ABC of life support
Oxygen and I.V access
Stabilize cervical spine

16. Blood glucose
Control seizures
Consider I.V glucose, thiamine, naloxone,
flumazenil

17. Brief examination and obtain history
Investigate
Reassess the situation and plan further