What Does Patients Consciousness Classification Mean?
Consciousness is generally classified based on the degree of awareness and the content of consciousness. According to the level of consciousness awareness, it can be divided into wakefulness, somnolence, lethargy, and coma. Coma can be further categorized into shallow coma, moderate coma, and deep coma based on different degrees of unconsciousness. Alternatively, if classified based on changes in consciousness content, it is primarily divided into confusion and delirium. Both of these conditions result in decreased recognition and response capabilities to the surrounding environment, as well as impaired orientation abilities. Patients with delirium may even exhibit impulsive and aggressive behaviors.
(1) Wakefulness: The individual has a good ability to recognize themselves and their surroundings, including correct temporal, spatial, and personal orientation. When asked about their name, age, location, time, etc., they can provide accurate answers.
(2) Somnolence: This is a form of consciousness impairment primarily characterized by a decrease in clarity of consciousness. The patient's level of consciousness is slightly reduced, but they can be immediately awakened by calling or shaking their limbs. They can engage in brief and correct conversations or perform simple actions, but they fall asleep again once the stimulus is removed. At this time, reflexes such as swallowing, pupil response, and corneal reflex are still present.
(3) Confusion: This refers to a deeper level of consciousness impairment compared to somnolence. The patient cannot clearly perceive external stimuli, has impaired spatial and temporal orientation, and exhibits dull or erroneous comprehension and judgment. Memory is blurred, with poorer recent memory, and the impression of the real environment is unclear with disconnected thinking and slow mental activity. Generally, when a patient exhibits temporal and spatial orientation disorders, it is referred to as confusion.
(4) Lethargy: This is a deeper level of decreased consciousness clarity compared to confusion. Calling or shaking the limbs does not elicit a response. However, pressing on the inner margin of the supraorbital ridge can cause a defensive reflex in the facial muscles (or by pinching the hands or feet). At this time, deep reflexes are hyperactive, with tremor and involuntary movements. Reflexes such as corneal and eyelash reflexes are weakened, but the pupillary light reflex is still present.
(5) Shallow coma: The patient loses voluntary movement, does not respond to calls, and has no reaction to general stimuli. However, they may respond to strong painful stimuli such as pressing on the supraorbital ridge or the nail bed. Superficial reflexes are absent, but tendon reflexes, glossopharyngeal reflexes, corneal reflexes, and pupillary light reflexes are present. Respiratory and pulse rates remain relatively unchanged. This condition is commonly seen in severe cerebrovascular diseases, encephalitis, brain abscesses, brain tumors, poisoning, early stages of shock, and hepatic encephalopathy.
(6) Deep coma: The patient does not respond to any stimuli and remains completely motionless. Corneal reflexes and pupillary light reflexes are absent, and there is incontinence of urine and feces. Respiration is irregular, and blood pressure decreases. At this stage, decerebrate posturing may occur. Later, the patient's muscles become flaccid, the eyeballs are fixed, and the pupils dilate, indicating proximity to death. This condition is seen in hepatic encephalopathy, pulmonary encephalopathy, cerebrovascular diseases, brain tumors, brain trauma, severe poisoning, and late stages of shock.
(7) Delirium: This is an acute impairment of consciousness characterized by disorientation, delusions, hallucinations, emotional instability, and disordered behavior. Sometimes, fragmentary delusions may occur. Symptoms often fluctuate with lighter symptoms during the day and more severe symptoms at night. Patients may be somnolent during the day and agitated at night. Due to the influence of delusions or hallucinations, patients may exhibit self-harming or aggressive behaviors. Delirium can be caused by various factors, including poisoning, infection, trauma, severe metabolic or nutritional disorders, etc.
