bubble_chart Overview

Complete loss of consciousness is the most severe form of consciousness disorder, representing a state of high-level inhibition of advanced neural activity. Intracranial lesions and metabolic encephalopathy are the two major categories of disease causes.

bubble_chart Diagnosis

I. History Taking

1. Focus on understanding the onset and progression of unconsciousness. Acute onset is commonly seen in trauma, infection, poisoning, cerebrovascular diseases, and shock.

2. Determine whether unconsciousness is the initial symptom. If it occurs during the course of the disease, identify the symptoms preceding unconsciousness. For example, diabetic patients may experience hyperosmolar unconsciousness or hypoglycemic unconsciousness, cirrhotic patients may develop hepatic unconsciousness, and hyperthyroid patients may present with thyroid storm.

3. Inquire about any history of trauma.

4. Ask about exposure to pesticides, carbon monoxide, sedatives, toxic plants, or other poisons.

5. Investigate the presence of underlying medical conditions that may cause unconsciousness, such as diabetes, kidney disease, liver disease, or severe cardiopulmonary diseases.

6. For patients with transient unconsciousness, consider conditions like epilepsy or syncope.

II. Physical Examination Findings

1. Carefully observe body temperature, respiration, blood pressure, pulse, skin, and head/neck condition. High fever may indicate severe infection, summerheat stroke, pontine hemorrhage, or atropine poisoning; hypothermia may suggest shock, myxedema, hypoglycemia, sedative poisoning, or frostbite disease. Bradycardia may point to intracranial hypertension, atrioventricular block, or myocardial infarction, while tachycardia is often seen in ectopic cardiac rhythms, fever, or heart failure. Changes in respiratory patterns can help localize brain lesions. Note breath odor (fruity in diabetic ketoacidosis, urinous in uremia, foul in hepatic unconsciousness, alcoholic in alcohol intoxication, garlic-like in organophosphate poisoning). Hypertension may occur in cerebral hemorrhage, hypertensive encephalopathy, or intracranial hypertension, while hypotension is common in shock, myocardial infarction, or sedative poisoning. Cherry-red skin suggests CO poisoning; petechiae may indicate septicemia or epidemic meningitis. Dry skin is seen in anticholinergic drug poisoning or summerheat stroke, whereas cold, clammy skin with profuse sweating suggests shock. Check for bleeding or discharge from the ears, nose, or conjunctiva as evidence of traumatic injury pattern.

2. Neurological examination should assess for focal neurological signs, pupillary and fundoscopic findings, defensive or facial responses to supraorbital pressure, withdrawal response to plantar scraping, eye position, symmetry of tendon reflexes, and pathological reflexes. Papilledema and hemorrhage are common in intracranial hypertension and subarachnoid hemorrhage. Bilateral dilated pupils occur in cerebral hypoxia, atropine-like drug poisoning, or severe midbrain lesions. Pinpoint pupils are seen in pontine tegmentum hemorrhage, organophosphate, or morphine-like drug poisoning. Unilateral pupillary dilation suggests ipsilateral uncal herniation, while unilateral constriction may indicate Horner’s syndrome or early ipsilateral uncal herniation.

3. Check for meningeal irritation signs, which are common in central nervous system infections and intracranial hemorrhagic diseases.

III. Ancillary Tests

Lumbar puncture (for cerebrospinal fluid cytology, generation and transformation, viral cell series), cranial CT, and MRI are invaluable for diagnosing central nervous system diseases. Blood carboxyhemoglobin testing aids in diagnosing CO poisoning. Abnormal urinalysis is common in uremia, diabetes, and acute porphyria. Suspected hepatic unconsciousness warrants blood ammonia and liver function tests. Blood glucose and renal function tests help diagnose diabetic ketoacidosis, hypoglycemic unconsciousness, and uremic unconsciousness. Electrocardiography can identify myocardial infarction or arrhythmias causing unconsciousness.

bubble_chart Treatment Measures

1. Patients with unconsciousness should be hospitalized as soon as possible to identify the cause and receive targeted treatment.

2. For those temporarily unable to be hospitalized, symptomatic treatment can be administered in outpatient clinics first.

① Maintain airway patency, administer oxygen, use respiratory stimulants, and perform tracheotomy or intubation for artificial assisted ventilation (respiration) if necessary during seasonal epidemics.

② Maintain effective blood circulation, administer cardiotonic and vasopressor drugs, and correct shock.

③ For patients with high intracranial pressure, administer intracranial pressure-reducing drugs such as 20% mannitol, furosemide, or glycerol, and perform lateral ventricular puncture and drainage if necessary.

④ Prevent or treat infections.

⑤ Control hypertension and excessively high body temperature.

⑥ Use diazepam, phenobarbital, etc., to relieve spasms.

⑦ Correct typical edema and electrolyte imbalances, and provide nutritional support.

⑧ Administer brain metabolism enhancers such as ATP, coenzyme A, citicoline, or cerebrolysin.

⑨ Administer awakening-promoting drugs such as Xingnaojing or Peaceful Palace Bovine Bezoar Pill.

⑩ Provide care for the oral cavity, respiratory tract, urinary tract, and skin.