Acute change in consciousness — a sudden decline in alertness or unresponsiveness — emergency evaluation/transfer.

Delirium with a dangerous cause — sepsis, hypoglycemia, hypoxia, or a stroke suggested by the workup — escalate/transfer per the relevant pathway.

New focal neurologic deficit with the cognitive change — activate the stroke pathway (route to the Neurological reference).

Safety emergency — agitation creating imminent danger — ensure safety and follow the crisis pathway (no restraints as a convenience).