Acutely Altered Consciousness - Different States

What Is an Altered Level of Consciousness?

The awareness of internal and external existence is called consciousness. A conscious person will be aware of the self and the surroundings. If a person is not wide awake or alert and cannot understand or react normally, the person is said to be in an altered level of consciousness. Altered levels of consciousness have multiple states. It may be caused by one or more of the following reasons:

• Infections.

• Certain medications.

• Head injury.

• Alcohol.

• Some diseases like diabetes.

• Severe dehydration.

• Drug abuse.

What Are the States of Acutely Altered Consciousness?

The following are the states of acutely altered consciousness:

• Lethargy: Lethargy is a mildly decreased or depressed level of consciousness. The person can be aroused with minimal difficulty. Lethgargy resembles drowsiness, and hence, the person becomes sleepy and sluggish. A lethargic person lacks the mental and physical energy to respond to stimuli. In this state, the person may be unable to think and may have decreased alertness, altered mood, and brain fog (a mental condition characterized by confusion, decreased mental clarity, and forgetfulness). In addition, the person may also experience shortness of breath, pale skin, and altered heart rate. They may also be unable to perform functions like movement of extremities or speaking. The facial expression might also show alterations as the person might not be able to control the functioning of the facial muscles. They need touch or verbal stimulation to respond.

• Obtund: In the case of obtundation, the patient feels a decreased interest and awareness in the surrounding environment. Their response to stimuli becomes even more reduced. They may need to get stimulated multiple times to respond. A gentle touch or verbal stimulation might not make them respond. They will sleep for a prolonged period and feel desi in between sleep. Even with the required impulse, they cannot arise completely from sleep. Extremely slow response and sleepiness are the characteristics of obtundation.

• Stupor: A person in a stupor requires repeated and vigorous stimulation to arise. The patient easily gets back to the state of unconsciousness if no stimulation is given. This will be marked by severe unresponsiveness. In other words, it will be nearly impossible to arouse a person in a stupor state. It is characterized by deep sleep. Extreme painful stimulation may make the person wake up. The person may be unable to follow what others are saying and to talk or communicate about self-requirements.

• Coma: Coma is the unarousable state of acutely altered consciousness. The patient will not respond to any stimulus, not even pain. The pupils of their eyes do not respond to light. They may not feel a gag sensation. Coma is due to severely depressed brain function. Illness or injury causing brain damage leads to prolonged and deep unconsciousness.

What Is the Glasgow Coma Scale?

The Glasgow Coma Scale helps assess an individual's consciousness level. Based on the scale, numbers will be given related to the alertness and other characteristics that the person shows. It plays a vital role in the neurological examination. It measures three categories- eye, motor, and verbal response. The eye response scoring ranges from 1 to 4; 1 corresponds to a lack of eye-opening, and 4 corresponds to the ability to open the eye independently. The verbal response scoring ranges from 1 to 5. Score 1 denotes the inability to speak or make sounds, and 5 denotes that the person is oriented and can correctly answer the questions. The motor response scoring ranges from 1 to 6. Score 1 indicates that the person cannot respond to pressure, and 6 indicates that the person can follow instructions and knows when to move. Glasgow coma scale-P is similar to the above-mentioned Glasgow Coma Scale with an addition of an element that scores the pupil of the eye. The pupil scoring ranges from 0 to 2. 2 means no pupil reacts to light, 1 means one pupil does not respond to light, and 0 means both pupils react to light. From the Glasgow Coma Scale score, the obtained pupil score will be subtracted to get the Glasgow Coma Scale-pupil score, which ranges from 1 to 15.

What to Expect in the Hospital?

In the hospital, the person may be observed, monitored, tested, and treated to cure the type of unconsciousness faced. The hospital staff will check the heart rate, blood pressure, and heart rate. The heartbeat will be constantly tracked using a cardiac monitor. The oxygen level, range of motion, and ability to feel pain will also be checked and monitored. The following tests will be performed in the hospital:

• Tests to check blood sugar levels.

• Blood and urine examination to check for certain organ functioning.

• Neurological examination to test for sensation, memory, and reflexes.

• CT or computed tomography scan to check for brain injuries or diseases.

• MRI or magnetic resonance imaging to check for any brain conditions leading to unconsciousness.

• X-rays to diagnose the underlying factors.

After monitoring and diagnosing the condition leading to acutely altered levels of consciousness, the patient will be provided with the required treatments. A tube will be inserted into the hand or arm vein. The tube or the intravenous (IV) catheter helps deliver the medications to the patient, as the patient may not be able to take them up consciously. The patient will receive oxygen through a small tube or a mask. In severe cases, the oxygen tube will be put into the lungs. In addition, medicines for infection and swelling will also be given.

Conclusion

A normal person is said to be conscious due to staying alert, responsive, awake, and aware. When they become unaware of the internal and external environment, they are said to be in a state of unconsciousness. Acutely altered levels of consciousness may be due to many conditions affecting the brain or central nervous system. It ranges from a state where the person is sleepy but responsive to deep levels of unconsciousness without response to extreme pain. Sleeping itself is not a state of unconsciousness. However, if the person fails to respond to a stimulus after waking up, it can be problematic.