Which of the following is the most serious complication of a patient with altered level of consciousness?

Choice A: Sepsis is a serious infection that occurs when the body's immune system overreacts to an injury or illness. It can cause organ failure and death. People with spinal cord injury are more prone to sepsis because they may have impaired bladder and bowel function, skin breakdown, or reduced sensation that can lead to infections.

Choice B: Pulmonary embolism is a blockage of an artery in the lungs by a blood clot. It can cause chest pain, shortness of breath, and death. People with spinal cord injury are more at risk of pulmonary embolism because they may have reduced mobility, blood circulation, or breathing capacity that can promote blood clot formation.

Choice C: Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or fungi. It can cause fever, cough, and difficulty breathing. People with spinal cord injury are more susceptible to pneumonia because they may have weakened cough reflex, impaired lung function, or aspiration of food or saliva into the lungs.

Choice D: All of the above are major causes of death related to spinal cord injury. They can occur separately or together and can be prevented or treated with proper medical care and lifestyle modifications.

Choice A: Flaccidity is not an early sign of intracranial pressure, but rather a late sign of brainstem compression or damage.

Choice B: Projectile vomiting is not an early sign of intracranial pressure, but rather a sign of increased pressure in the posterior fossa or cerebellum.

Choice C: Stupor is not an early sign of intracranial pressure, but rather a sign of severe impairment of consciousness or coma.

Choice D: Changes in level of consciousness is an early sign of intracranial pressure, as it reflects the brain's response to decreased oxygen and increased pressure.