Altered Consciousness & Coma

Adapted from Rosens, chp 16. 

Little Old Lady Workup (LOL)

Testing to consider in an elderly patient with altered mental status
ABG: hypoxia, CO2 retention, SOB
BMP/CMP: electrolyte abnormalities, hepatic encephalopathy
UA: infection, DKA, ingestion
PT/INT: hemorrhage, anemia, hypercoagulable
Lactate: ketotic state, ingestion, ischemia
TSH: thyroid storm, hypothyroid
Cardiac Enzymes: MI, ischemia, cardiogenic shock
CXR: infection, pneumothorax, CHF
CT head: hemorrhage, mass
MRI: edema, mass, ischemia
CTA: pulmonary emboli, aortic dissection
LP/CSF: infection, ICP

Confusion

Organic Confusion

Acute onset confusion with fluctuating consciousness and poor recent memory, possibly associated with focal deficits, hallucinations or abnormal vital signs. 

Functional Confusion

Chronic or slow-onset, normally alert and oriented, with some agitation or anxiety, possibly auditory hallucinations and normal vitals, no focal deficits, and illusions or delusions.