| Evaluation |
| Vital signs and general examination |
| Neurologic examination and GCS |
| Screening laboratories (CBC, glucose, electrolytes, BUN, creatinine, PT, PTT, ABG, LFTs, drug screen) |
| ECG |
| Head CT scan: prioritize emergent if focal neurologic signs, papilledema, fever |
| Lumbar puncture: prioritize emergent after CT scan if fever, elevated WBC, meningismus; otherwise do according to level of suspicion for diagnosis or if cause remains obscure |
| EEG: for possible nonconvulsive seizure, or if diagnosis remains obscure |
| Other laboratory tests: blood cultures, adrenal and thyroid tests, coagulation tests, carboxyhemoglobin, specific drug concentrations – do according to level of suspicion for diagnosis or if cause remains obscure |
| Brain MRI with DWI, if cause remains obscure |
| Management |
| ABCs: |
| Intubate if GCS ≤8 |
| Stabilize cervical spine |
| Supplement O2 |
| IV access |
| Blood pressure support as needed |
| Glucose 50 percent IV 50 mL (after blood drawn, before results back) |
| Thiamine 100 mg IV |
| Treat definite seizures with phenytoin or equivalent |
| Consider empiric treatments: |
| For possible infection: |
| Ceftriaxone and vancomycin |
| Acyclovir |
| For possible ingestion: |
| Naloxone |
| Flumazenil |
| Gastric lavage/activated charcoal |
| For possible increased ICP: |
| Mannitol |
| For possible nonconvulsive status: |
| Lorazepam |
| Phenytoin or equivalent |
