The level of consciousness can be assessed as soon as you introduce yourself to the patient. Is the patient awake? Alert? Is the patient's sensorium clouded by exogenous or endogenous insults? Does the patient appear confused? If the patient does not respond to your introduction, hold the patient's hand and softly say, ''Hello, Mr./Ms. _, can you hear me?
If you hear me, squeeze my hand.'' If there is no response, try gently shaking the patient. If there is still no response and the patient appears obtunded, squeezing the nipple or applying pressure with your thumb to the bony ridge under the eyebrow is a painful maneuver that may rouse the patient. If these maneuvers fail to awaken the patient, the patient is in coma. Patients who are in coma are completely unconscious and cannot be roused even by painful stimuli. If either painful stimulus is used, be careful not to pinch the skin or bruise the patient. If friends or relatives are present, make sure to explain to them what you are doing.
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