Altered Mental Status

Table of Contents

Aliases

Confusion, altered level of consciousness

Patient Care Goals

  1. Identify treatable causes
  2. Protect patient from harm

Patient Presentation

Inclusion Criteria

Impaired decision-making capacity

Exclusion Criteria

Traumatic brain injury

Patient Management

Assessment
Look for treatable causes of altered mental status:

  1. Airway – Make sure airway remains patent; reposition patient as needed
  2. Breathing – Look for respiratory depression;
    1. Mandatory to check SPO2 & ETCO2
    2. If available, use CO detector
  3. Circulation – Look for signs of shock
  4. Glasgow Coma Score and/or AVPU
  5. Pupils
  6. Neck rigidity or pain with range of motion
  7. Stroke tool
  8. Blood glucose level
  9. EKG – Arrhythmia limiting perfusion
  10. Breath odor – Possible unusual odors include alcohol, acidosis, ammonia
  11. Chest/Abdominal – Intra-thoracic hardware, assist devices, abdominal pain or distention
  12. Extremities/skin – Track marks, hydration, edema, dialysis shunt, temperature to touch (or if able, use a thermometer)
  13. Environment – Survey for pills, paraphernalia, ambient temperature

Treatment and Interventions

  1. Oxygen [see Universal Care guideline]
  2. Glucose [see Hypoglycemia or Hyperglycemia guidelines]
  3. Naloxone [see Opioid Poisoning/Overdose guideline]
  4. Restraint: physical and chemical [see Agitated or Violent Patient/Behavioral Emergency guideline]
  5. Anti-dysrhythmic medication [see Cardiovascular section guidelines for specific dysrhythmia guidelines]
  6. Active cooling or warming [see Hypothermia/Cold Exposure or Hyperthermia/Heat Exposure guidelines]
  7. IV fluids [see fluid administration doses in Shock and Hypoglycemia or Hyperglycemia guidelines]
  8. Vasopressors [see Shock guideline]

Notes – Altered Mental Status