Key messages

• If intubation is required the stability of the cervical spine must be assessed.

• A key part of the immediate evaluation is the patient's vital signs, which may themselves help decide the cause of unconsciousness.

• Hypoglycemia can be catastrophic to the central nervous system, with the degree of injury determined by the length of time and level of the low blood glucose.

• Prior to giving glucose, thiamine 1 mg/kg must be administered intravenously to prevent precipitation of acute Wernicke's encephalopathy.

• Specific causes of unconsciousness such as elevated intracranial pressure, drug intoxication, seizures, meningitis, or metabolic encephalopathy must be sought and treated.

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