Altered sensorium is a broad term encompassing various levels of impaired consciousness, ranging from confusion to complete unresponsiveness. This condition can be caused by numerous underlying pathologies, including metabolic disorders, infections, neurological injuries, and psychological factors. Prompt identification and management are crucial in the intensive care unit (ICU) to prevent morbidity and mortality. This write-up elaborates on the step-by-step approach depicted in the flowchart for managing patients with altered sensorium in the ICU (Ref. Algorithm 1.1).