Evaluation of the Obtunded Patient
First Things First (assess & treat for the following)
- Airway assessment
- Altered mental status may indicate compromised ability to protect airway.
- GCS 8 or less requires airway protection (eg, ETT).
Glasgow Coma Scale
- 6 = Appropriate
- 5 = Localizes to pain
- 4 = Nonpurposeful
- 3 = Decorticate posturing: upper extremities flex, lower extremities extend
- 2 = Decerebrate posturing: fully extends
- 1 = No movement
- Eye Opening
- 4 = Spontaneous opening
- 3 = Opens to stimulation
- 2 = Opens to strong stimulation
- 1 = Does not open
- 5 = Appropriate
- 4 = Confused
- 3 = Inappropriate words
- 2 = Incomprehensible sounds
- 1 = No response
- Alterations in breathing pattern may indicate site of lesion.
- Mechanical support may be required to maintain adequate ventilation & oxygenation.
- Circulation (see Circulation)
- Goal is to maintain cerebral perfusion pressure (CPP) at least 60 mmHg.
- If ICP is unknown, then goal of MAP >90 mmHg until ICP can be determined
- General physical exam
- Other clinical exams as directed by clinical suspicion
- Focused history & general medical exam
- ICU neuro exam
- This MUST be performed w/ attention to detail!
- Treat immediate conditions.
- Seizures, herniation, malignant hypertension, etc.
- Appropriate diagnostic tests
- Neuroimaging (eg, CT or MRI), EEG, labs, etc.
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Last updated: May 5, 2010
"Evaluation of the Obtunded Patient." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534020/all/Evaluation_of_the_Obtunded_Patient.
Evaluation of the Obtunded Patient. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534020/all/Evaluation_of_the_Obtunded_Patient. Accessed June 2, 2023.
Evaluation of the Obtunded Patient. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534020/all/Evaluation_of_the_Obtunded_Patient
Evaluation of the Obtunded Patient [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2023 June 02]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534020/all/Evaluation_of_the_Obtunded_Patient.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Evaluation of the Obtunded Patient ID - 534020 Y1 - 2010/05/05/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534020/all/Evaluation_of_the_Obtunded_Patient PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -