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©2013 UpToDate ® Print Email Emergent evaluation and management of stupor and coma in adults EVALUATION Vital signs and general examination Neurologic examination and GCS Screening laboratories (CBC, glucose selectrolyes, BUN, creatinine, PT, PTT, ABG, LFTs, drug screen) ECG Head CT scan: prioritize emergent if focal neurologic signs, papilledema, fever Lumbar puncture: prioritize emergent after CT scan if fever, elevated WBC, meningismus; otherwise do according to level of suspicion for diagnosis or if cause remains obscure EEG: for possible nonconvulsive seizure, or if diagnosis remains obscure Other laboratory tests: blood cultures, adrenal and thyroid tests, coagulation tests, carboxyhemoglobin, specific drug concentrations - do according to level of suspicion for diagnosis or if cause remains obscure Brain MRI with DWI, if cause remains obscure MANAGEMENT ABCs: Intubate if GCS ≤8 Stabilize CSpine Supplement O2 IV access Blood pressure support as needed Glucose 50 percent IV 50 mL (after blood drawn, before results back) Thiamine 100 mg IV Treat definite seizures with phenytoin or equivalent Consider empiric treatments: For possible infection: Ceftriaxone and Vancomycin Acyclovir For possible ingestion: Naloxone Flumazenil Gastric lavage/activated charcoal For possible increased ICP: Mannitol For possible nonconvulsive status: Lorazepam Phenytoin or equivalent GCS: Glasgow coma scale; CBC: complete blood count; BUN: blood urea nitrogen; PT: prothrombin time; PTT: partial thromboplastin time; ABG: arterial blood gas; LFT: liver function tests; ECG: electrocardiogram; CT: computed tomography; WBC: white blood cells; EEG: electroencephalography; MRI: magnetic resonance imaging; DWI: diffusion weighted imaging; ICP: intracranial pressure.