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States of Impaired Sensorium

Precise definitions and descriptions of the various levels of consciousness are helpful in establishing a baseline, communicating with other health care providers, and interpreting changes in a patient’s condition. Box 58-1describes definitions for varying levels of consciousness; however, many terms used to describe alterations in sensorium lack precision and are better avoided. Colloquial use of the terms lethargy, obtundation, somnolence, and stupor have rendered them imprecise, and health care workers are best served to avoid them when describing patients with altered consciousness. Numerous scoring systems have been developed to assess acute neurologic conditions. By far the most common is the Glasgow Coma Scale (GCS). Developed to classify the depth of coma in adults who have sustained a head injury, the use of the GCS has been expanded to evaluate patients who have sustained a variety of neurologic injuries. A GCS score of eight or less has been used …