Differential diagnosis of consciousness disturbances

1. Big picture

Disturbance of consciousness is an emergency symptom, not a diagnosis. The examiner expects a safe clinical algorithm:

Airway, Breathing, Circulation → check glucose immediately → look for focal neurological signs/trauma/infection/toxins/metabolic causes → treat reversible killers while investigating.

The most dangerous mistakes are:

• forgetting hypoglycemia,
• missing stroke/intracranial bleeding,
• missing sepsis/meningitis,
• missing CO₂ narcosis/hypoxia,
• treating “confusion” as psychiatric before excluding organic disease.

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