Notes – Altered Mental Status

Altered Mental Status

Patient Safety Considerations

  1. With depressed mental status, initial focus is on airway protection, oxygenation, ventilation, and perfusion
  2. The violent patient may need pharmacologic and/or physical management to insure proper assessment and treatment
  3. Hypoglycemic and hypoxic patients can be irritable and violent [see Agitated or Violent Patient/Behavioral Emergency guideline]

Notes/Educational Pearls

Key Considerations

  1. History from bystanders
  2. Age of the patient
  3. Environment where patient found
  4. Recent complaints (e.g. headache, chest pain, difficulty breathing, vomiting, fever)
  5. Pill bottles/medications:
    1. Anticoagulants
    2. Anti-depressants
    3. Narcotic pain relievers
    4. Benzodiazepines
  6. Medical alert tags and accessory medical devices
  7. Evaluate for reduced PO intake and/or vomiting and/or diarrhea or dehydration as a cause of AMS in the pediatric and geriatric populations
  8. Medications a child may have access to including but not limited to:
    1. Antihypertensives
    2. Oral hypoglycemic
    3. Opioids
    4. Benzodiazepines
    5. Antiepileptics

Pertinent Assessment Findings

  1. Track marks
  2. Breath odor
  3. Skin temperature
  4. Location

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914113 – Medical-Altered Mental Status

Key Documentation Elements

  • GCS or AVPU description
  • Temperature was taken when able
  • Patient and medic safety were considered
  • Pupil and neck exam were done

Performance Measure

  • Hypoglycemia considered and treated appropriately
    • Blood glucose level obtained.
    • EMS Compass® Measure (for additional information, see http://www.emscompass.org)
      • Hypoglycemia-01: Treatment administered for hypoglycemia. Measure of patients who received treatment to correct their hypoglycemia
    • Sepsis considered as a possible cause of hypotension
    • Hypotension appropriately treated
    • Naloxone is used as therapeutic intervention, not a diagnostic tool
    • CO detector is used when available

References

  1. Frisch A, Miller T, Haag A, Martin-Gill C, Guyette FX, Suffoletto BP. Diagnostic accuracy of a rapid checklist to identify delirium in older patients transported by EMS. Prehosp Emerg Care, 2013 Apr-Jun; 17(2): 230-4.
  2. Kumar A, Roberts D et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med, 2006 Jun; 34(6): 1,589–96.
  3. Leong LB, Jian KH, Vasu A, Seow E. Prospective study of patients with altered mental status: clinical features and outcome. Int J Emerg Med, 2008 Sep; 1(3): 179–82.