- Assess consciousness/responsiveness
- Assess ABCs, neurologic exam
- If with focal deficits or signs of increased ICP – perform imaging (noncontrast CT, CTA?, MRI?)
- ABG: hypercapnea or hypoxia
- Na, BUN/Crea, Glu, Ca, Mg, Phos
- CSF studies / infectious work-up
- EKG, cardiac enzymes
- continuous EEG
- withdrawal? (review history – ETOH, benzodiazepine use)
- medications? (review med list – sedatives, analgesics, antipsychotics, anticholinergics)
- residual effects of anesthesia?
Algorithm for evaluation of altered mental status after neurosurgery
*Residual anesthesia can temporarily unmask predisposition to focal deficit. If this is the case the focal neurologic change will improve with dissipation of anesthetic effects.
Bhardwaj, Anish, and Marek Alexander Z Mirski. Handbook Of Neurocritical Care. New York: Springer, 2010. Print.