⚠️ Coma & Altered Consciousness · Emergency Decision Tool

Schwartz Clinical Handbook — Chapter 21 · GCS · Brainstem reflexes · Herniation · Toxic/metabolic · Seizure · Trauma · Meningitis

Select onset, exam findings (pupils, posturing, brainstem reflexes), vital signs, and history → identify etiologies (trauma, infection, metabolic, ingestion) and guide immediate resuscitation.
🚨 ABCs first: Airway, Breathing, Circulation. Treat hypoglycemia, administer naloxone, consider sepsis/meningitis.

📋 Step 1 — Clinical & neurologic features
📌 Diagnostic impressions
📖 Schwartz Ch 21

Select onset (sudden vs progressive), pupillary findings, motor posturing, respiratory pattern, meningismus, and history of trauma/ingestion → system generates differential (trauma, meningitis, DKA, metabolic, seizure, toxic) and emergent management.

✔️ Pinpoint pupils + respiratory depression → opioid overdose.
✔️ Fever + nuchal rigidity → meningitis / encephalitis.
✔️ Unilateral fixed dilated pupil → herniation / mass.
✔️ Decorticate → hemispheric; decerebrate → brainstem.
📘 Schwartz pearls (Chapter 21)
• GCS ≤8 → intubate.
• Herniation signs: Cushing triad (hypertension, bradycardia, irregular breathing).
• Immediate bedside glucose, naloxone, thiamine.
• Non‑contrast head CT before LP if mass suspected.