Early detection of neurological deterioration in patients means interventions are more likely to be successful (CCSO 2015)
Therefore, you must be informed about the possible causes of neurological deterioration, know how to correctly assess the patient and intervene appropriately.
What is Neurological Deterioration?
Neurological deterioration can be defined as a decrease of two or more points on the Glasgow Coma Scale (GCS), which measures a patient’s level of consciousness on a scale of 3 to 15 (Shkirkova et al. 2018).
Patients may present in a variety of consciousness states ranging from full alertness and awareness, to some level of impairment, to complete unawareness and unresponsiveness (Cooksley, Rose & Holland 2018).
A patient with a GCS score of less than eight is considered to be neurologically compromised, which is a medical emergency relying on prompt diagnosis and medical management for a favourable patient outcome (Cooksley, Rose & Holland 2018).
While a neurological assessment is useful for recognising deterioration, the cause will need to be identified so that the patient can be appropriately treated. The following are some common causes of neurological deterioration:
Sedation-related neurological deterioration may be caused by opiate overdose or anaesthetic that has not been reversed effectively, causing the patient to remain heavily sedated.
The patient may present with:
Respiratory decline or a decrease in respiratory rate. This may cause apnoea, which is a medical emergency;
Drowsiness or unresponsiveness (in the case of opiate overdose);
Airway obstruction or hypoxia (may occur if an anaesthetic has not been reversed appropriately).
(Vincent et al. 2018; CEC 2013; Schiller et al. 2020)
Hypoglycaemia (abnormally low glucose levels) can cause neurological deterioration, as the brain relies on blood glucose for energy (Harvard Medical School 2019). It may be caused by:
Administration of insulin;
Excessive alcohol consumption; and
Other causes of neurological deterioration include:
Traumatic brain injury;
Lack of oxygen (e.g. from drowning or a heart attack)
Toxins (e.g. carbon monoxide); and
Drugs and alcohol.
(Mayo Clinic 2018)
Managing Neurological Deterioration
Assess the patient using the GCS in conjunction with a head-to-toe assessment.
Assess the patient’s level of consciousness.
Ensure the patient is free from any environmental danger. If the patient is on the floor, call for assistance and only move them to the bed if they are haemodynamically stable and all manual handling equipment is available.