Obtunded
Formal Definition
A state of reduced consciousness characterized by diminished awareness, decreased responsiveness to stimuli, and slowed mentation — more severe than confusion or drowsiness but less severe than stupor or coma.
How It's Used on the Ward
"He's obtunded" — not fully responsive, hard to rouse, slow to answer. A step above stupor on the consciousness scale.
Example
""GCS 11: opens eyes to voice, confused speech, withdraws to pain. Documented as obtunded. Urgent ABG, glucose, ammonia, tox screen. CT head ordered. Family at bedside.""
Clinical Context
The consciousness spectrum: alert → lethargic → confused → obtunded → stuporous → comatose. Obtunded patients respond to strong stimuli but not fully or appropriately. Always pair with GCS score for precise documentation. Differential for acutely obtunded: hypoglycemia (check first, it's reversible), opiates/benzos (Narcan/flumazenil), hepatic encephalopathy, hypercapnia, ICH, meningitis/encephalitis, severe electrolyte disturbance.