Emergency Medicine/Altered mental status

From Wikibooks, open books for an open world
< Emergency Medicine
Jump to navigation Jump to search


  • Decreased conscious state drowsy stupor: non responsiveness to pain or painful procedures
  • Delirium - altered perception, hallucination
  • Lethargy - decreased activity, loss of eye contact


A mnemonic to work-through of the possible causes of altered mental state (AMS).

  • A — Alcohol/Acidosis
  • E — Endocrine/Epilepsy/Electrolytes/Encephalopathy
  • I — Insulin
  • O — Opiates, Overdose
  • U — Uremia/Underdose
  • T — Trauma - head injury, blood loss (shock).
  • I — Infection- meningitis, encephalitis, sepsis, septic shock; pneumonia, urinary tract infection, occult osteomyelitis.
  • P — Poisoning/Psychosis/pharmacology
  • S — Stroke/Seizure/syncope

What to do ?[edit]

Start the usual ...

  • ABC - adequate ventilation, adequate oxygen, cervical spine protection if required, airway protection if required
  • Oxygen
    • adequate circulation (BP, PR , periphery)
    • IV access
  • Cardiac monitor
  • Quarrantine or Reverse Isolation (if appropriate)
What happened ( caregiver, witness ) ?
History of Presentation
Past Medical History
Allergies, Medications, Drug/Substance Use 
Physical Examination
 Vital signs - Temp, BP,  PR, RR, Oximetry  
 Chest, Abdominal , Head/Eyes, Neurological, 
 Skin = check for ominous changes (purpura, rash, infections...)


 blood sugar (fingerstick)
 electrolyte panel
 liver function tests
 toxicology screen
 carbon monoxide level (in appropriate scenario)
 thyroid function tests
 CT Head
 lumbar puncture
 Abdo US

Quick Fixes -

   low glucose level - IV dextrose
   hypoxia - give oxygen
   pinpoint pupils not breathing - IV nalaxone (for opiates on board)
   seizure, stop - IV diazepam (or lorazepam... another benzo)
   cold - warm up
   suspect sepsis - IV antibiotics empiric. ?blood culture x 2 first. If difficult do later.
                  antibiotics before LP is ok (complete the LP within one hour of starting the med)