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The judgable
component of a conscious state is the quality of consciousness itself and its content. The content of
consciousness describes the whole of the cerebral cortex function, including cognitive function and
attitude in response to a stimulus. Patients with consciousness disorders usually appear to be fully
conscious, but can not respond well to some stimuli, such as discriminating colors, facial features,
recognizing language or symbols, so it is often said that the patient appears confused4. Decreased
consciousness or coma becomes a hint of malfunctioning brain integrity and as a "final common
pathway" of organ failure such as heart failure, breathing and circulation will lead to brain failure with
death. So, if there is a decrease in awareness of disregulasi and dysfunction of the brain with the
tendency of failure of all body functions. In terms of assessing the decrease in consciousness, there are
known terms used in the clinic of compost mentis, somnolen, stupor or sopor, mild coma and coma.
The terminology is qualitative. Meanwhile, the decline in consciousness can also be quantitatively
assessed, using the Glasgow4 coma scale.
Two simpler scales ACDU (alert, confused, drowsy, unresponsive), and AVPU (alert, response to
voice, response to pain, unresponsive). The AVPU scale is a quick and easy way to assess the level of
awareness. This examination is ideal as a preliminary and quick assessment, consisting of: 2 • Alert •
Response to sound • Response to pain • Loss of consciousness AVPU is included in some early
warning scoring systems for critical patients, as a simpler way than GCS, but not suitable for long-term
observation2.
a) S: Circulation Includes stroke and heart disease b) E: Encephalitis Keeping in mind the existence of
systemic infection / sepsis that may be underlying or appearing simultaneously. c) M: Metabolic For
example hyperglycemia, hypoglycemia, hypoxia, uremia, hepatic coma d) E: Electrolyte For example,
excessive diarrhea and vomiting. e) N: Neoplasm Both primary and metastatic brain tumors f) I:
Intoxication Intoxication of various drugs and chemicals can cause a decrease in consciousness g) T:
Trauma Especially capitis trauma: komusio, kontusio, epidural bleeding, subdural hemorrhage, can
also trauma abdomen and chest. h) E: Epilepsy Post-attack Grand Mall or on status epilepticus can
cause decreased awareness
The diagnostic approach is no different from other cases, ie through the order of anamnesis, neurologic
physical examination, and investigation. The difference lies in the demands of the speed of thinking
and acting. Anamnesis (disease history) Decreased Awareness2 Ask the patient or in the introduction
to the surroundings of the onset and the course of the illness. Some important points to ask: - Awitan:
time, surroundings. - Patient age is an important part of history. In previously healthy patients, younger
age, conscious decline occurs abruptly, the possible cause of drug poisoning, subarachnoid
hemorrhage, or head trauma. While in old age, a sudden decrease in consciousness is more likely due
to cerebral bleeding or infarction. - Symptoms that precede in detail (confusion, headache, weakness,
dizziness, vomiting, or seizures), focal symptoms such as difficulty speaking, unable to read, memory
changes, disorientation, numbness or pain, motor weakness, reduced encephal , vision changes,
difficulty in swallowing, hearing loss, step or balance disorders, tremor. - Use of drugs or alcohol. -
History of heart disease, lung, liver, kidney, or anything else