Altered Mental Status
Summary: <br> Mnemonic: AEIOU-TIPS<br> <br> <br> <br> Step 1: Evaluate the Airway<br> <br> <br> <br> * 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?<br> <br> <br> <br> Step 2: Point of Care Labs<br> <br> <br> <br> * Finger stick blood glucose* EKG* Dysrhythmia?* Ischemia? * Abnormal intervals?* Pregnancy test<br> <br> <br> <br> Step 3: Consider Naloxone<br> <br> <br> <br> * 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)<br> <br> <br> <br> Step 4: Consider Differential Diagnosis<br> <br> <br> <br> * 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<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Round 1 – Altered Mental Status <a href="http://www.emclerkship.com/round-1-0-0/">(EM Clerkship)</a>* Approach to Altered Mental Status <a href="https://www.saem.org/cdem/education/online-education/m4-curriculum/group-m4-approach-to/approach-to-altered-mental-status">(SAEM)</a><br>
