意識水準、意識レベル

WordNet

talk frankly with; lay it on the line; "I have to level with you"
become level or even; "The ground levelled off" (同)level off
indicator that establishes the horizontal when a bubble is centered in a tube of liquid (同)spirit_level
height above ground; "the water reached ankle level"; "the pictures were at the same level"
an abstract place usually conceived as having depth; "a good actor communicates on several levels"; "a simile has at least two layers of meaning"; "the mind functions on many strata simultaneously" (同)layer, stratum
tear down so as to make flat with the ground; "The building was levelled" (同)raze, rase, dismantle, tear down, take_down, pull down
not showing abrupt variations; "spoke in a level voice"; "she gave him a level look"- Louis Auchincloss (同)unwavering
aim at; "level criticism or charges at somebody"
being on a precise horizontal plane; "a billiard table must be level"
oriented at right angles to the plumb; "the picture is level"
an alert cognitive state in which you are aware of yourself and your situation; "he lost consciousness"
the basic unit of money in Bulgaria

PrepTutorEJDIC

(土地などが)『平らな』,水平な,凸凹のない / 『同じ高さ(程度)の』 / 《話》精神状態がよくつり合いのとれた,分別のある / 〈U〉〈C〉(地位・程度などの一般的な)『標準』,『水準』,レベル / 〈C〉(高さ・深さの基準となる)『水平面』,水平線 / 〈C〉〈U〉(ある物と比べたときの)『高さ』,深さ / 〈C〉(建物の)階,層 / 〈C〉《おもに米》(水準器《英》spirit level) / 〈物の表面〉‘を'『平らにする』 / 〈木・家など〉‘を'倒す / 〈地位・程度など〉‘を'一様にする,平均する / 《『level』+『名』+『at』+『名』》(目標に)〈銃など〉の水準器を合わせる / 《『level』+『名』+『at』(『against』)+『名』〈人〉》(人に)〈非難など〉‘を'浴びせる / 水平に,平らに
《所有・所属》…『の』,…のものである,…に属する・《材料・要素》…『でできた』,から成る・《部分》…『の』[『中の』] ・《数量・単位・種類を表す名詞に付いて》…の・《原因・動機》…『で』,のために(because of) ・《主格関係》…『の』,による,によって・《目的格関係》…『を』,の・《同格関係》…『という』・《関係・関連》…『についての』[『の』],の点で・《抽象名詞などと共に》…の[性質をもつ] ・《『It is』+『形』+『of』+『名』+『to』 doの形で,ofの後の名詞を意味上の主語として》・《分離》…『から』・《起原・出所》…『から』[『の』](out of) ・《『名』+『of』+『a』(『an』)+『名』の形で》…のような・《『名』+『of』+『mine』(『yours, his』など独立所有格)の形で》…の…・《時》(1)《副詞句を作って》…に《形容詞句を作って》…の・《時刻》《米》…前(to,《米》before)
意識,知覚 / (個人や集団の)意識,精神,意見
OLD French古[代]フランス語

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/09/24 14:43:25」(JST)

wiki en

An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment.^[1] A mildly depressed level of consciousness or alertness may be classed as lethargy; someone in this state can be aroused with little difficulty.^[1] People who are obtunded have a more depressed level of consciousness and cannot be fully aroused.^[1]^[2] Those who are not able to be aroused from a sleep-like state are said to be stuporous.^[1]^[2] Coma is the inability to make any purposeful response.^[1]^[2] Scales such as the Glasgow coma scale have been designed to measure the level of consciousness.

An altered level of consciousness can result from a variety of factors, including alterations in the chemical environment of the brain (e.g. exposure to poisons or intoxicants), insufficient oxygen or blood flow in the brain, and excessive pressure within the skull. Prolonged unconsciousness is understood to be a sign of a medical emergency.^[3] A deficit in the level of consciousness suggests that both of the cerebral hemispheres or the reticular activating system have been injured.^[4] A decreased level of consciousness correlates to increased morbidity (sickness) and mortality (death).^[5] Thus it is a valuable measure of a patient's medical and neurological status. In fact, some sources consider level of consciousness to be one of the vital signs.^[3]^[6]

Definition

Scales and terms to classify the levels of consciousness differ, but in general, reduction in response to stimuli indicates an altered level of consciousness:

**Levels of consciousness**
Level	Summary (Kruse)^[2]	Description
Metaconscious	Preternatural	People who possess the ability to monitor and control their own cognitive processes in addition to meeting all the criteria indicative of a normal level of consciousness. In the field of cognitive neuroscience, metacognitive monitoring and control have been viewed as functions of the prefrontal cortex, which receives sensory input signals from divergent cortical regions and implements control through feedback loops which are established utilizing the underlying mechanisms of neuroplasticity (see chapters by Schwartz & Bacon and Shimamura, in Dunlosky & Bjork, 2008).^[7]
Conscious	Normal	Assessment of LOC involves checking orientation: people who are able promptly and spontaneously to state their name, location, and the date or time are said to be oriented to self, place, and time, or "oriented X3".^[8] A normal sleep stage from which a person is easily awakened is also considered a normal level of consciousness.^[9] "Clouding of consciousness" is a term for a mild alteration of consciousness with alterations in attention and wakefulness.^[9]
Confused	Disoriented; impaired thinking and responses	People who do not respond quickly with information about their name, location, and the time are considered "obtuse" or "confused".^[8] A confused person may be bewildered, disoriented, and have difficulty following instructions.^[9] The person may have slow thinking and possible memory time loss. This could be caused by sleep deprivation, malnutrition, allergies, environmental pollution, drugs (prescription and nonprescription), and infection.
Delirious	Disoriented; restlessness, hallucinations, sometimes delusions	Some scales have "delirious" below this level, in which a person may be restless or agitated and exhibit a marked deficit in attention.^[2]
Somnolent	Sleepy	A somnolent person shows excessive drowsiness and responds to stimuli only with incoherent mumbles or disorganized movements.^[8]
Obtunded	Decreased alertness; slowed psychomotor responses	In obtundation, a person has a decreased interest in their surroundings, slowed responses, and sleepiness.^[9]
Stuporous	Sleep-like state (not unconscious); little/no spontaneous activity	People with an even lower level of consciousness, stupor, only respond by grimacing or drawing away from painful stimuli.^[8]
Comatose	Cannot be aroused; no response to stimuli	Comatose people do not even make this response to stimuli, have no corneal or gag reflex, and they may have no pupillary response to light.^[8]

Glasgow Coma Scale

The most commonly used tool for measuring LOC objectively is the Glasgow Coma Scale (GCS). It has come into almost universal use for assessing people with brain injury,^[2] or an altered level of consciousness. Verbal, motor, and eye-opening responses to stimuli are measured, scored, and added into a final score on a scale of 3–15, with a lower score being a more decreased level of consciousness.

Others

The AVPU scale is another means of measuring LOC: people are assessed to determine whether they are alert, responsive to verbal stimuli, responsive to painful stimuli, or unresponsive.^[3]^[6] To determine responsiveness to voice, a caregiver speaks to, or, failing that, yells at the person.^[3] Responsiveness to pain is determined with a mild painful stimulus such as a pinch; moaning or withdrawal from the stimulus is considered a response to pain.^[3] The ACDU scale, like AVPU, is easier to use than the GCS and produces similarly accurate results.^[10] Using ACDU, a patient is assessed for alertness, confusion, drowsiness, and unresponsiveness.^[10]

The Grady Coma Scale classes people on a scale of I to V along a scale of confusion, stupor, deep stupor, abnormal posturing, and coma.^[9]

Differential diagnosis

A lowered level of consciousness indicate a deficit in brain function.^[4] Level of consciousness can be lowered when the brain receives insufficient oxygen (as occurs in hypoxia); insufficient blood (as occurs in shock); or has an alteration in the brain's chemistry.^[3] Metabolic disorders such as diabetes mellitus and uremia can alter consciousness.^[11] Hypo- or hypernatremia (decreased and elevated levels of sodium, respectively) as well as dehydration can also produce an altered LOC.^[12] A pH outside of the range the brain can tolerate will also alter LOC.^[9] Exposure to drugs (e.g. alcohol) or toxins may also lower LOC,^[3] as may a core temperature that is too high or too low (hyperthermia or hypothermia). Increases in intracranial pressure (the pressure within the skull) can also cause altered LOC. It can result from traumatic brain injury such as concussion.^[11] Stroke and intracranial hemorrhage are other causes.^[11] Infections of the central nervous system may also be associated with decreased LOC; for example, an altered LOC is the most common symptom of encephalitis.^[13] Neoplasms within the intracranial cavity can also affect consciousness,^[11] as can epilepsy and post-seizure states.^[9] A decreased LOC can also result from a combination of factors.^[11] A concussion, which is a mild traumatic brain injury (MTBI) may result in decreased LOC.

Pathophysiology

Although the neural science behind alertness, wakefulness, and arousal are not fully known, the reticular formation is known to play a role in these.^[9] The ascending reticular activating system is a postulated group of neural connections that receives sensory input and projects to the cerebral cortex through the midbrain and thalamus from the retucular formation.^[9] Since this system is thought to modulate wakefulness and sleep, interference with it, such as injury, illness, or metabolic disturbances, could alter the level of consciousness.^[9]

Normally, stupor and coma are produced by interference with the brain stem, such as can be caused by a lesion or indirect effects, such as brain herniation.^[9] Mass lesions in the brain stem normally cause coma due to their effects on the reticular formation.^[14] Mass lesions that occur above the tentorium cerebelli (pictured) normally do not significantly alter the level of consciousness unless they are very large or affect both cerebral hemispheres.^[9]

Diagnostic approach

Assessing LOC involves determining an individual's response to external stimuli.^[11] Speed and accuracy of responses to questions and reactions to stimuli such as touch and pain are noted.^[11] Reflexes, such as the cough and gag reflexes, are also means of judging LOC.^[11] Once the level of consciousness is determined, clinicians seek clues for the cause of any alteration.^[9] Usually the first tests in the ER are pulse oximetry to determine if there is hypoxia, serum glucose levels to rule out hypoglycemia. A urine drug screen may be sent. A CT head is very important to obtain to rule out bleed. In case, meningitis is suspected, a lumbar puncture must be performed. A serum TSH is an important test to order. In select groups consider vitamin B12 levels. Checking serum ammonia is not advised.^{[citation needed]}

Treatment

Treatment depends on the degree of decrease in consciousness and its underlying cause. Initial treatment often involves the administration of dextrose if the blood sugar is low as well as the administration of oxygen, naloxone and thiamine.

References

^ ^a ^b ^c ^d ^e Kandel ER; Jessell, Thomas M.; Schwartz, James H. (2000). Principles of neural science. New York: McGraw-Hill. p. 901. ISBN 0-8385-7701-6. Retrieved 2008-07-03.
^ ^a ^b ^c ^d ^e ^f Porth C (2007). Essentials of Pahtophysiology: Concepts of Altered Health States. Hagerstown, MD: Lippincott Williams & Wilkins. p. 835. ISBN 0-7817-7087-4. Retrieved 2008-07-03.
^ ^a ^b ^c ^d ^e ^f ^g Pollak AN, Gupton CL (2002). Emergency Care and Transportation of the Sick and Injured. Boston: Jones and Bartlett. p. 140. ISBN 0-7637-1666-9. Retrieved 2008-07-04.
^ ^a ^b Porth, p. 838
^ Scheld et al.. p. 530
^ ^a ^b Forgey WW (1999). Wilderness Medicine, Beyond First Aid (5th ed.). Guilford, Conn: Globe Pequot. p. 13. ISBN 0-7627-0490-X. Retrieved 2008-07-04.
^ Dunlosky, J. & Bjork, R. A. (Eds), Handbook of Metamemory and Memory. Psychology Press: New York.
^ ^a ^b ^c ^d ^e Kruse MJ (1986). Nursing the Neurological and Neurotrauma Patient. Totowa, N.J: Rowman & Allanheld. pp. 57–58. ISBN 0-8476-7451-7.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m Tindall SC (1990). "Level of consciousness". In Walker HK, Hall WD, Hurst JW. Clinical Methods: The History, Physical, and Laboratory Examinations. Butterworth Publishers. Retrieved 2008-07-04.
^ ^a ^b Posner JB, Saper CB, Schiff ND, Plum F (2007). Plum and Posner's Diagnosis of Stupor and Coma. Oxford University Press, USA. p. 41. ISBN 0-19-532131-6.
^ ^a ^b ^c ^d ^e ^f ^g ^h von Koch CS, Hoff JT (2005). "Diagnosis and management of depressed states of consciousness". In Doherty GM. Current Surgical Diagnosis and Treatment. McGraw-Hill Medical. p. 863. ISBN 0-07-142315-X. Retrieved 2008-07-04.
^ Johnson AF, Jacobson BH (1998). Medical Speech-language Pathology: A Practitioner's Guide. Stuttgart: Thieme. p. 142. ISBN 0-86577-688-1. Retrieved 2008-07-04.
^ Scheld WM, Whitley RJ, Marra CM (2004). Infections of the Central Nervous System. Hagerstown, MD: Lippincott Williams & Wilkins. p. 219. ISBN 0-7817-4327-3. Retrieved 2008-07-04.
^ Tindall SC (1990). "Level of consciousness". In Walker HK, Hall WD, Hurst JW. Clinical Methods: The History, Physical, and Laboratory Examinations. Butterworth Publishers. Retrieved 2008-07-04. Mass lesions within monkey coma by virtue of direct effects on the reticular formation of monkey

UpToDate Contents

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1. 成人における昏迷および昏睡 stupor and coma in adults
2. 成人における精神状態検査 the mental status examination in adults
3. せん妄および錯乱状態の診断 diagnosis of delirium and confusional states
4. 小児における先天性中枢性低換気症候群および睡眠関連低換気症のその他の原因 congenital central hypoventilation syndrome and other causes of sleep related hypoventilation in children
5. 成人におけるノンレム睡眠からの覚醒障害 disorders of arousal from non rapid eye movement sleep in adults

English Journal

The Coma Recovery Scale Modified Score: a new scoring system for the Coma Recovery Scale-revised for assessment of patients with disorders of consciousness.

Sattin D1, Minati L, Rossi D, Covelli V, Giovannetti AM, Rosazza C, Bersano A, Nigri A, Leonardi M.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.Int J Rehabil Res.2015 Dec;38(4):350-356.
The differential diagnosis between vegetative state and minimally conscious state is still complex and the development of an evaluation systems is one of the challenging tasks for researchers and professionals. The Coma Recovery Scale-revised is considered the gold standard for clinical/behavioral a
PMID 26465775

Medical Rapid Response in Psychiatry: Reasons for Activation and Immediate Outcome.

Manu P1,2,3, Loewenstein K4,5, Girshman YJ4, Bhatia P4, Barnes M4, Whelan J4, Solderitch VA6, Rogozea L7, McManus M4.
The Psychiatric quarterly.Psychiatr Q.2015 Dec;86(4):625-32. doi: 10.1007/s11126-015-9356-4.
Rapid response teams are used to improve the recognition of acute deteriorations in medical and surgical settings. They are activated by abnormal physiological parameters, symptoms or clinical concern, and are believed to decrease hospital mortality rates. We evaluated the reasons for activation and
PMID 25796608

A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy.

Maruyama M1, Miyasaka Y1, Takano A1, Inoue M1, Furuya K1, Sugai H1, Hada M1, Nakagomi H1.
Surgical case reports.Surg Case Rep.2015 Sep 24;1:88. eCollection 2015.
Hyperammonemic encephalopathy is rarely caused by a urinary diversion. We herein experienced a case of rectal carcinoma with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy. A 72-year-old man suffered from a fever, diarrhea, pneumaturia, and fecaluria beginning in April
PMID 26435908

Japanese Journal

幼児用ズボンの購入及び着用実態に関する研究　－ウエスト部の締め付けに着目して－

山田由佳子,井上真理
大阪教育大学紀要　第Ⅱ部門　社会科学・生活科学 63(1), 29-38, 2014-09-30
… The aim of this study is to clarify the issues with regard to purchasing infants' trousers, including its current situation and things to be concerned. …
NAID 120005479207

ドメスティック・バイオレンス被害女性の周産期および育児期を通じたDV被害に対する認識の回復過程

藤田景子
日本看護科学会誌 34(1), 198-207, 2014-09-25
… The purpose of this study is to reveal how aspects of the recovery process of women who have suffered from domestic violence by their partners (DV) during the perinatal and childrearing periods changed in their recognition toward victimization.Method: Adopting qualitative and descriptive research design, we conducted semi-structured interviews with 21 female DV victims.Results: 4 categories were extracted as recovering processes for female domestic violence victims during their perinatal and …
NAID 120005478701

超級話者へのアクセント教育で向上しやすいものと向上しにくいもの

河野俊之
日本語教育方法研究会誌 21(2), 56-57, 2014-09-06
… It is often said that for learners of Japanese to acquire Japanese accent, they can only memorize each word individually. … In this paper, the results of the accent practice for superior-level speakers are reported. … During the practice, a Korean learner read aloud sentences in a textbook and compared her own pronunciation to that of the recorded sentences read by a native speaker. …
NAID 110009843505

Related Pictures

★リンクテーブル★

リンク元	「意識水準」
拡張検索	「depressed level of consciousness」「altered level of consciousness」
関連記事	「level」

「意識水準」

Altered level of consciousness
	An intracranial hemorrhage, one cause of altered level of consciousness
Classification and external resources
ICD-10	R40
ICD-9-CM	780.0
	[edit on Wikidata]