1. OTEP Sept 2015

2. When you roll up on scene and you see and hear an asthmatic breathing 40 time a min, you have a pretty good idea of what's going on. But when you come across a confused and altered patient it can be a bit more challenging to find out what the problem is. Some times it’s obvious what the problem is and sometimes it is not. But doing a through physical exam, history and checking a blood sugar are the basic’s to figure it out.

3.  Largest differential diagnosis pool  History and patient exam critical  Pay attention to surroundings to look for cues  Document what you see well  Manage the basics

4.  There are a few mnemonic's that are helpful in remembering most of the possible causes for AMS. The one that is easiest for me to remember and has the most options is AEIOUTIPS. I have yet to have a patient that falls outside of this.

5.  A- Alcohol  E- Epilepsy  I- Insulin  O-Overdose  U- Uremia  T- Trauma  I- Infection  P- Psychiatric/ poisoning  S- Stroke/ shock

6.  First on the list for a reason  Largest percentage of AMS encountered  Oder on breath  Check environment for clues Easiest one to fool you

7.  Seizure?  Medical history  Prescription medicine  Oral trauma? Incontinence?  Repetitive focal movement  AMS sudden onset?

8.  Check blood sugar, ALWAYS in AMS  Check refrigerator for insulin  Medical alert tags  Insulin pump  Glucometer or lancets

9.  Medication bottles; pill count add up?  Drug paraphernalia on scene  Check pupils  Nose and mouth for residue Oxygenation  Hypoxic event  Patent airway  Lung sounds  Skin  Home oxygen supply

10.  UTI- geriatric Smells, incontinence  Renal disease  Jaundice  Weakness  Dehydration Underdose  Rx noncompliance?

11.  Head injury- Acute/ TBI  Assaulted  Good physical exam  Mechanism- recreate the scene  Look for other bleeding

12.  Recently ill Already on oral ABX, need stronger IV antibiotics  Sepsis- > 2 = sepsis  Vitals, including temperature  Diastolic pressure greater than pulse rate = volume depletion  Hypotension  Weakness

13.  Rx non compliance  History  Acute psychotic episode Poisoning  Intentional vs unintentional  Environment- ingestion, absorbed, inhaled

14.  Anything that might put pressure on brain  Occlusive/ hemorrhagic  Lesions/ tumors  Shock- Hemodynamically stable?  Septic  Cardiogenic  Anaphylactic  Patient exam (neuro)  FAST exam  Motor deficits