Conscious State | Mental Status Exam - MedSchool
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Mental Status Exam
 
 
Mental Status Exam
 
 
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The patient's level of consciousness is an assessment of their wakefulness and responsiveness to external stimuli.
 

Conscious State

 
 
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Overview

  • The patient's level of consciousness is an assessment of their wakefulness and responsiveness to external stimuli.

The Glasgow Coma Scale (GCS)

  • The Glasgow coma scale (GS) is a 15-point scale that uses three components - eye opening, response to voice and motor response - to indicate a patient's level of consciousness. Originally developed for use in trauma patients, this scale is now used on an every day basis to assess patients in an acute setting.
    • How to Assess

    • If the patient is not spontaneously opening their eyes, begin by attempting to elicit a response verbally. If this is unsuccessful then apply a painful stimulus such as a trapezius squeeze or a sternal rub.
  • If not done in this order, the examiner is unable to determine whether the patient responded to the painful stimulus or the voice.
    • Interpretation

    • The Glasgow Coma Scale (GCS)
    • Causes of Unconsciousness

    • Intracranial

    • Haemorrhage - intracerebral, subarachnoid, subdural, extradural
    • Infarction
    • Infection - meningitis, encephalitis, abscess
    • Tumour - mass effect, cerebral oedema
    • Post ictal state
    • Head trauma - vascular, hypoxia, cerebral oedema, parenchymal injury
    • Psychiatric - conversion, depression, catatonia
    • Extracranial

    • Cardiovascular - shock, hypertension
    • Infection - septicaemia
    • Metabolic - hypo/hyperosmolar states, hypo/hyperglycaemia, hypoadrenalism, hypothyroidism, hypopituitarism, electrolyte abnormality, hypoxia, hepatic failure, renal failure
    • Drugs / toxins - sedatives, analgesics, alcohol, encephalopathy
    • Physical injury - hyper / hypothermia, electrocution
Last updated on November 7th, 2019
 
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