Level of Consciousness

Level of consciousness (LOC) is a measurement of a person's arousability and

responsiveness to stimuli from the environment.
A mildly depressed level of consciousness may be classed as lethargy;
someone in this state can be aroused with little difficulty.

People who are obtunded have a more depressed level of consciousness and cannot be
fully aroused.

Those who are not able to be aroused from a sleep-like state are said to be stuporous.

Coma is the inability to make any purposeful response. Scales such as the Glasgow coma
scale have been designed to measure level of consciousness.

An altered level of consciousness can result from a variety of factors, including

alterations in the chemical environment of the brain (e.g. exposure to poisons),
insufficient oxygen or blood flow in the brain, and excessive pressure within the skull.
Prolonged unconsciousness is understood to be a sign of a medical emergency. A deficit
in the level of consciousness suggests that both of the cerebral hemispheres or the
reticular activating system have been injured. A decreased level of consciousness
correlates to increased morbidity (disability) and mortality (death). Thus it is a valuable
measure of a patient's medical and neurological status. In fact, some sources consider
level of consciousness to be one of the vital signs.

Levels
Scales and terms to classify the levels of consciousness differ, but in general, reduction in
response to stimuli indicates decreasing level of consciousness (see table at right).
Assessment of LOC involves checking orientation: people who are able promptly and
spontaneously to state their name, location, and the date or time are said to be oriented to
self, place, and time, or "oriented X3".[7] A normal sleep stage from which a person is
easily awakened is also considered a normal level of consciousness.[8] "Clouding of
consciousness" is a term for a mild alteration of consciousness with alterations in
attention and wakefulness.[8] People who do not respond quickly with information about
their name, location, and the time are considered "obtuse" or "confused".[7] A confused
person may be bewildered, disoriented, and have difficulty following instructions.[8]
Some scales have "delirious" below this level, in which a person may be restless or
agitated and exhibit a marked deficit in attention.[2] A somnolent person shows excessive
drowsiness and responds to stimuli only with incoherent mumbles or disorganized
movements.[7] In obtundation, a person has a decreased interest in the surroundings,
slowed responses, and sleepiness.[8] People with an even lower level of consciousness,
stupor, only respond by grimacing or drawing away from painful stimuli.[7] Comatose
people do not even make this response to stimuli, have no corneal or gag reflex, and they
may have no pupillary response to light.[7]

Levels of consciousness

Level Description
Conscious Normal
Confused Disoriented; impaired thinking and responses
Delirious Disoriented; restlessness, hallucinations, sometimes delusions
Obtunded Decreased alertness; slowed psychomotor responses
Stuporous Sleep-like state (not unconscious); little/no spontaneous activity
Comatose Cannot be aroused; no response to stimuli