Evaluation of the Obtunded Patient

Evaluation of the Obtunded Patient is a topic covered in the Pocket ICU Management.

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First Things First (assess & treat for the following)

ABCs

  • Airway assessment
    • Altered mental status may indicate compromised ability to protect airway.
    • GCS 8 or less requires airway protection (eg, ETT).

Glasgow Coma Scale

  • Motor
    • 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
  • Speech
    • 5 = Appropriate
    • 4 = Confused
    • 3 = Inappropriate words
    • 2 = Incomprehensible sounds
    • 1 = No response
  • Breathing
    • 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

Citation

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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 -