Initial management

• Perform an ABCDE survey.

• Identify clinical features of underlying AMS etiologies.

• Calculate coma scores.

• Check POC glucose.

• Obtain routine laboratory studies (see “Diagnostics for AMS”).

• Plan for early neuroimaging if CNS cause is suspected.

Use coma scores to quickly assess and document neurological function at presentation and regularly reassess to detect changes.

In patients with abrupt-onset AMS or coma, consider seizure, stroke, cardiac event, overdose, or intoxication.

Perform the following concurrently with the initial evaluation, based on clinical suspicion:

• Address rapidly-reversible causes, e.g.:

  • Treat respiratory failure.

  • Treat shock.

  • Treat hypoglycemia.

  • Manage acute seizures.

  • Administer antidotes, e.g., naloxone for opioid overdose.

• Initiate protective measures, e.g.:

  • Airway protection

  • C-spine immobilization for trauma

  • Neuroprotective measures for CNS injury

• Begin time-sensitive management steps: e.g., antibiotics for sepsis

Next steps

• Once the patient is stabilized, proceed with a full clinical and diagnostic evaluation.

• See the following management approaches for specific causes and/or manifestations of AMS:

  • ”Management of delirium”

  • ”Approach to the agitated or violent patient”

  • ”Approach to psychosis”

  • ”Approach to the poisoned patient”

  • ”Management of ischemic stroke” and “Overview of stroke”

  • “Moderate and severe TBI management”