GOTIMES

G – Glucose

Check fingerstick as VS in every altered pt

O – O2/CO2/CO

Consider hypoxia, hypercapnia as causes

Consider season and ask CO questions in every altered pt – others in family sick too?

T – Tox/Trauma

Most common tox includes EtOH but many other toxidromes including anticholinergic, BZD, opiates. Check pupils and pits in physical exam.

Also includes EtOH w/d

Consider occult trauma e.g. NAT in children

I – Infection/Infarct

Delirium as sequelae of any infection but also meningitis or encephalitis

AMS d/t MI

M – Metabolic

Hepatic, renal, hypertensive

E – Electrolytes/Endocrine/Environment

Hypo/hypernatremia, hypercalcemia

Hypoglycemia, DKA/HHS, myxedema coma, thyroid storm

Hypo/hyperthemia, carbon monoxide

S – Stroke/Seizure/SAH/Space Occupying Lesion

AMS in post ictal state ofter seizure or can have fluctuating AMS d/t non-convulsive status epilepticus. Consider if h/o sz DO, evidence of automatisms, or if other w/u is negative.

Posterior fossa CNS lesions not seen well on CT. Remember to of the basilar syndrome can cause coma/locked in syndrome.