From hypoglycemia to intracranial bleeding: a fixed method that keeps you from missing the reversible cause.
Hypoglycemia
Mimics everything — check it immediately in every altered patient.
Hypoxia / hypercapnia
Before any neurological explanation: is oxygenation and ventilation adequate?
Intracranial bleed / stroke
Focal signs or a unilateral blown pupil = urgent imaging.
Poisoning (opioids and beyond)
Pinpoint pupils with slow breathing: naloxone.
CNS infection
Fever + neck stiffness + altered mentation — do not delay antibiotics.
The golden trio — glucose, oxygen, naloxone — is reversible within a minute.
Never attribute altered consciousness to alcohol before excluding what is deadlier.
Recovery position when no trauma, field glucose when possible, airway protection during transport.
Usually non-focal, chronic disease history.
Focal signs, abrupt onset, severe headache.
Exposure history, characteristic pupils, empty containers.
Fever, neck stiffness, rash.
Clinical pearl
Record GCS by its three components (eye/verbal/motor), not just the sum — decline in one component is an early alarm.
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This content is an educational reference and does not replace clinical judgement or local protocols.
