Altered Mental Status

Mnemonic: AEIOU-TIPS Step 1: Evaluate the Airway * General principles* “If they can’t speak, they can’t control their airway”* “If GCS is <8, intubate”* In the real world, it’s a clinical judgement call* Postictal patients?* Intoxicated patients? Step 2: Point of Care Labs * Finger stick blood glucose* EKG* Dysrhythmia?* Ischemia? * Abnormal intervals?* Pregnancy test Step 3: Consider Naloxone * Classic dose – 0.4 to 2mg IV/IM* Many start with lower doses to lower chance of severe withdrawal* Can also be given intranasal (2-4mg) Step 4: Consider Differential Diagnosis * Mnemonic: AEIOU-TIPS* *Note: You don’t need to order all of these tests on every patient with altered mental status!!!* Alcohol* Blood alcohol level* Thiamine* Endocrine/Electrolytes* Includes* Hypoglycemia* Hepatic encephalopathy* Myxedema coma* Hyponatremia* Obtain* Electrolyte panel* Hepatic panel* TSH* Ammonia* Ischemia (Cardiac)* EKG* Troponin* Opiates* Uremia* Trauma* CT head without contrast* CT cervical spine without contrast* Infection* Urinalysis* Chest x-ray* Lumbar puncture* CBC* Lactic acid* Blood cultures* Poisoning* Stroke* CT head without contrast* Neuro exam for focal deficits Additional Reading * Round 1 – Altered Mental Status (EM Clerkship)* Approach to Altered Mental Status (SAEM)