SHM's Clinical Quick Talks-Approach to Acute Altered Mental Status

Pdf Summary

This document provides an approach to assessing and managing patients with acute altered mental status (AMS). The first step is to stabilize the patient by performing a primary assessment, addressing the airway, breathing, circulation, and blood glucose. Depending on the situation, additional help and resources may be needed, such as calling for anesthesia if there are concerns about the airway or breathing. <br /><br />The next step is to gather the patient's history, including the last known normal, past medical history, and any recent medications or procedures. If the patient has received narcotics, consider treating with naloxone. <br /><br />A focused exam should then be performed, assessing the patient's level of consciousness using the Glasgow Coma Scale and looking for any neurologic deficits or seizure-like activity. <br /><br />Directed management is then based on the findings of the exam. If there are neurologic deficits, a stroke may be suspected and a CT head without contrast and a CTA of the head and neck should be ordered. For seizure-like activity, the patient should be positioned safely and treated with lorazepam. If the patient is non-focal, sepsis should be considered and immediate action taken, such as giving IV fluids, ordering blood cultures and lactate, and starting broad spectrum antibiotics. <br /><br />Further diagnostics are not as time-sensitive and should be addressed after the patient has been stabilized. Suggested tests include a CBC, CMP, VBG/ABG, and various other laboratory tests depending on the situation. <br /><br />Some important considerations highlighted in the document include always assessing and addressing the immediate stability of the patient, involving appropriate resources early on, checking blood glucose, considering sepsis as a common cause of AMS, and avoiding moving unstable patients.

Asset Subtitle

Alexandra C. Collis, Vince Raikhel, Joseph R. Bell, David Carlbom

Keywords

acute altered mental status

assessing patients

primary assessment

airway

breathing

circulation

blood glucose

neurologic deficits

seizure-like activity

sepsis consideration