ALTERED MENTAL STATUS (FROM UNKNOWN CAUSE)

 Originated-1-25-2010

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DESIGNATION OF CONDITION

Signs and symptoms may include any or all of the following: limited or no response to verbal or painful stimuli, inappropriate responses, and irrational behavior without knowing the cause.  

EMPHASIS ON PATIENT CARE

ABCs, airway management, adequate perfusion.

FIRST RESPONDER MANAGEMENT

1. Initial Management -Assess airway, breathing and circulation and manage as indicated.  If occult trauma is possible, consider spinal immobilization.
2. Focused H&P -History, physical exam, vital signs, pupils, motor function

• When was the patient last completely well?
• What signs and symptoms were present before the change in level of consciousness (e.g., headaches, seizures, confusion, trouble breathing, etc.)?
• Patient’s medications?
• Compliant?
• Possible head trauma?
• Recreational drug use or alcohol abuse?
  

3. Consider possible causes:

• Diabetic Emergency
• Overdose
• CVA/TIA
• AMI
• Head Trauma
• Dehydration
• Syncope
• Hypo/Hyperthermia
• Shock or hypoperfusion
• CNS Infection
  

4. Perform glucometry If the glucose is < 60 mg/deciliter and there are associated signs and symptoms of Hypoglycemia, follow Diabetic Emergencies Protocols.

5. If patient exhibits signs and symptoms of shock, follow Shock Protocols.

6. If no ILS/ALS capability, radio for ILS or ALS intercepts.

7. If narcotic overdose is suspected, follow Poisoning/ Overdose Protocols.

BASIC PRE-HOSPITAL MANAGEMENT

8. If narcotic overdose or hypoglycemia is not suspected, transport the patient without                                                   
   delay to an appropriate medical facility.

INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

9. Establish IV access and infuse an isotonic solution to maintain adequate vital signs.
10. Consider intraosseous route (EMT-I) or intraosseous access (EMT-P) if patient condition warrants and peripheral IV site is unobtainable.
11. Paramedics should assess and monitor cardiac rhythm and treat as appropriate.

Note: D50 administration may be harmful for patients with ischemic brain injury. However, D50 should never be withheld in any patient suspected of hypoglycemia. When in doubt, treat for hypoglycemia if unable to perform glucometry.

In cases of altered mental status as a result of narcotic overdose, after NALOXONE administration, the patient may rapidly awaken and become combative. This should be considered prior to insertion of an advanced airway device.