At it's most simple level unconsciousness is the state of not being conscious. This can be considered to be a state in which an individual does not respond to people or environmental stimuli. Unconscious states include things like coma, through to more temporary unconscious states like faints.

So why should you care?
As healthcare professional's (or students) we tend to be firstly, in environments where we encounter individuals with varying levels of consciousness, secondly as healthcare professionals people look to us to do something about it. I also believe conscious state is an obvious, yet poorly understood vital sign, and it's important to have an idea of how to assess it. In light of this I also feel that it's appropriate that all health professionals have at least a rudimentary understanding of assessing consciousness.

Assessing Consciousness
Before we start assessing consciousness, it's important to note that loss of consciousness (e.g. unconsciousness) is different to altered state of consciousness. An altered state of consciousness implies that the individual still has some level of conscious awareness (i.e. responds to stimuli). Examples of altered state of consciousness include delirium and normal sleep. Anyway that's enough semantics for me. If you have any questions about the above, don't hesitate to ask in the comments section below.

In the following sections I shall show some of the ways of assessing loss of consciousness.

AVPU
AVPU stands for Alert, Voice, Pain, Unresponsive and is one the simplest systems by which someone can judge a person's level of consciousness.

Alert

• Awake, though not always oriented.
• You can assess orientation by asking questions like what is your name, where are you and what day is it?

Voice

• Responds to verbal stimulus.
• Can be in the form of voice (e.g. grunting), eyes or motor (e.g. moves a limb or hand)

Pain

• Responds to pain.
• Ways to elicit pain include; sternal rub, squeezing the trapezius muscle or fingers, poking with a pin.

Unconscious/Unresponsive

Glasgow Coma Scale
The Glasgow Coma Scale or GCS is one of the most common ways of assessing level of consciousness in a healthcare setting.

It is scored out of 15, with 15 being totally awake and alert and 3 being unresponsive.

There are three components which make up the GCS score.

• Motor (M - 6 points)
• Verbal (V - 5 points)
• Eye (E - 4 points)

GCS is important not only as measure of consciousness, but also because below a score of 9, patients are unable to properly protect their airway. However, just because a patient's GCS is above 8, does not necessarily mean that their airway is protected.

Below is how each individual component is scored, plus a nice overview diagram by Sketchy Medicine.

The important thing to remember is that the lowest score possible is 3.

Even a rock has a score of 3.

What about Young Children?

To deal with the fact that children aren't just little adults, an adapted form of the Glasgow Coma Scale was also developed.