A) If you found someone who appeared to be asleep with no signs of trauma or obvious medical condition, how would you treat them if it became apparent they could not be woken using normal methods?
Depends where they are found... this is actually not an unusual occurrence in patients staying in the hospital.
Usually you try to arouse them with noxious stimuli, i.e shouting, sternal rub, axillary pinch, etc. If they don't respond with anything (limb movement, faint vocalization, whatever), then they'd need more thorough neurologic exam including pupillary and corneal reflex, look in the back of their eyes (funduscopic exam), and then just thorough general physical exam. Basically you would look for signs of papilledema (sign of increased intracranial pressure) or posturing:
Abnormal posturing - Wikipedia, the free encyclopedia
You would also want a full set of vital signs. Any nonresponsive or mentally altered patient will also have a point-of-care glucose (d-stick) performed, since hypoglycemic coma is relatively common cause of this phenomenon.
If they are unresponsive and vitals are abnormal you would respond to whats abnormal. If they are desaturating, you would bag-valve mask ventilate them, and possible intubate them. If they have a fever, you would CT scan them and do a lumbar puncture. If they have low blood sugar, you would give them an ampule of D50 +/- thiamine (for a homeless alcoholic found laying in the gutter). Many people like this end up getting brain imaging in the form of a non-contrast CT scan. If there was concern for a non-convulsive seizure, the person would get an EEG.
And then there are a bunch of other things and nuances. If you have written this scene, it would be easier to give you advice in the form of a direct critique of the piece. There is really no one single set of steps involved in evaluating every person with undifferentiated altered mental status. You rely a lot on clinical suspicion which is determined by who the person is, where they are found down, their medical history, etc. For example, a teenager found by his parents unresponsive in his room would make me strongly think of something like drug overdose vs. 3 month old baby where I would think of some
inborn error of metabolism vs. 80 year old lady in nursing home which would make me think of something like
hyponatremia or stroke. Epidemiology and what's most likely in a given demographic play a big role in determining the workup.
B) If that person did not receive any form of medical attention, how long could the they remain in such a state before damage occurred?
Depends entirely on the cause. In general, very few things that cause someone to become completely unresponsive will resolve without intervention.
