Altered Mental Status Medical Emergencies

BONUS: Name this costume

GOALS Review the nine causes of altered mental status using the mnemonic AEIOU-TIPS. Review how to assess a patient with altered mental status. Demonstrate the treatment of a patient with altered mental status

JUST TO CLARIFY… A patient with altered mental status is any patient who’s level of responsiveness or awareness has changed.

Le Anatomy

2 TYPES OF AMS MALFUNCTIONS Local or focal: affects specific part or region of body Examples? Global: affecting all parts of the CNS equally Examples? LOCAL VS. GLOBAL

STROKES RECALL: Neurological impairment resulting from low or no blood flow to areas of the brain 3 TYPES Ischemic Hemorrhagic Transient Ischemic

CAUSES OF AMS WHAT ARE THE MOST COMMON CAUSES OF AMS? ASSESSMENT ACRONYM?

AEIOU-TIPS A: Alcohol and acidosis E: Epilepsy, environment, and electrolytes I: Insulin O: Oxygen and overdose U: Uremia T: Trauma and tumors I: Infection P: Poisoning and psychiatric conditions S: Seizure, stroke and syncope

ALCOHOL (& acidosis) It’s first on the list for a reason! Alcohol plays a large roll in a large percentage of altered mental states that we encounter. Does the patient have an odor on their breath? Does the environment suggest alcohol consumption? Acidosis: too much acid in the blood, medical condition

Ask Yourself: Does this environment suggest alcohol consumption? Disclaimer: This is a trained professional. Do not try these stunts at home.

An example of “altered” mental status. Ft. my sister

EPILEPSY (& Environment & Electrolytes) Epilepsy: Could the patient have had a seizure? Inquire about the patient’s past medical history, and check for prescription medications. Do you note any trauma or urinary incontinence? Look closely for repetitive focal movement. Was the onset of the altered mental state sudden?

A Note on Electrolytes AMS post-Tuckerman’s

INSULIN Check the patient’s body for evidence of diabetes (medical tags, insulin pump/patch, blood glucose meter) Could the patient be hypoglycemic (or hyperglycemic)? Low blood sugar is often the cause of AMS… Always keep this in mind!

OVERDOSE & OXYGENATION If medication bottles are present, does the pill count add up? Is there evidence of drug use at the scene? We talked about alcohol, but don’t forget about other substances that can cause mental status changes. Opiates (check pupils) Hallucinogens Inhalants Also consider an acute hypoxic event. Brain needs oxygen Airway patency, lung sounds and skin should be evaluated

UREMIA Does the patient have a history of renal failure or renal disease? (Think: kidney failure) Have they been urinating regularly? Look for signs of increased toxins in the blood (mainly nitrogen) Jaundice Recent fatigue Dehydration Unusual thirst or peripheral swelling

TRAUMA (& tumors) Could the patient have a head injury? Could there have been an unreported traumatic event? Could the patient have been assaulted? Could there have been a previous head injury that lead to the current change in mental status? (lucid interval) Your assessment should include a thorough look at the head as well as a search for causes of occult bleeding in the chest,

INFECTIONS Is there a source of infection? Has the patient been ill recently? Is the patient immuno-compromised? Are they in a high-risk category for sepsis such as kids, the elderly, and patients taking chemotherapy and other immuno-suppressive therapies? Feel patient’s skin, take temperature, pay attention to bp. (Most sepsis patients show some degree of hypotension before they become noticeably altered.)

PSYCHIATRIC & POISONING Non-compliance to medications can be an important factor. Does the patient have a history of psychiatric events? Consider the possibility of poisoning, both intentional and unintentional. Consider the environment where the patient was found. Could the patient have had contact with a poison? Ingestion is only one potential route for poison For ex: carbon monoxide is inhaled

STROKE & SHOCK Not just occlusive stroke, but anything that might put pressure on the brain. Lesions, tumors, spontaneous hemorrhage. Do a thorough neurological evaluation and look for motor deficits in the patient’s response to stimuli. Note muscular weakness in the face and take a good look at the pupils. We’ve talked about shock, but keep in mind how it can present with AMS

Medical Conditions Seizures Partial Generalized Grand mal Epilepsy Diabetes Hypoglycemia Hyperglycemia

ASSESSMENT Scene size-up Potential hazards removed or mitigated Is the cause of AMS traumatic or medical in nature? Two can occur together Trauma: think spine and airway Primary Assessment Assess LOR using Glasgow Coma Scale Assess need for additional resources Secondary assessment SAMPLE Look for medical card/jewelry if patient is unresponsive AEIOU-TIPS DCAP-BTLS Cause specific investigation

Treatment Reminders

Experiences to share, Comments, or Questions. Have you ever treated a patient with AMS? What knowledge/training was helpful to you during the treatment of this patient? Is there anything that you can share that other patrollers could benefit from when faced with similar patient care situations in the future?

Self-Check What are the nine common causes of altered mental status ? AEIOU-TIPS What are the ways we can adjust to better assess a patient with altered mental status? What are the golden-rules for treatment of a patient with altered mental status?

Thanks for your undivided attention

GOOD LUCK ON THE MIDTERM