A patient with reduced or rapidly dropping conscious level is at risk of developing airway compromise. They should be assessed by an airway trained doctor, and may require intubation.

If airway, breathing, circulation have been assessed and it is safe to do so, place the patient into recovery position.

Refer to local guidelines

Common drugs that cause CNS depression that can be treated:

Opiates can cause respiratory depression or coma, which can lead to respiratory arrest. Naloxone is an opiate antagonist which rapidly reverses this effect.

Initial emergency treatment (0-5 minutes)

• Apply oxygen and assess airway

• Intravenous benzodiazepines

Control treatment (5-20 minutes)

• Intravenous anti-convulsant

• Investigate and treat underlying cause (e.g. electrolyte imbalances)

• CT head scan / EEG

An urgent CT head can be time critical for a neurological deterioration. In patients with a rapidly dropping conscious level you will need to consider the need for intubation, as if there conscious levels continues to fall they may develop airway compromise.

When transferring these patients consideration should be taken about what personnel and equipment is required to safely move the patient. This is discussed further in Skills - Safe Transfer.