Altered mental status (AMS) refers to changes in mental state ranging from disorientation to unresponsiveness. AMS can be caused by traumatic head injury, poisoning, drug overdose, infection, shock, hypoxia, stroke, or diabetes. Signs of AMS include abnormal vital signs, unequal or sluggish pupils, abnormal skin condition, seizure activity, and irregular blood glucose levels depending on the cause. Patients exhibiting AMS fall under implied consent and must be transported to the hospital for further assessment and treatment.

1. AMS and Psychological Emergencies Brown University EMS March 4, 2007

17. Emergency Care Algorithm: Altered Mental Status Adapted from Fig. 17.9 of Brady, 7th ed. Ongoing assessment Head tilt-chin lift or jaw thrust Suction if necessary Airway adjunct PPV with O 2 Mechanism of injury present? Yes No Consider manual in-line stabilization Assess mental status Focused history and physical exam Assess circulation Transport Airway open? NRB 15 lpm History of diabetes and on medication to control diabetes? Able to swallow? Administer oral glucose Assess breathing Assess circulation NRB 15 lpm Rapid medical assessment Unable to obey commands, responsive only to painful stimuli or unresponsive Altered but responds to verbal stimuli and obeys commands No No Yes Yes Yes No Adequate Inadequate

18. Emergency Care Algorithm: Behavioral Emergency Adapted from Fig. 26.4 of Brady, 7th ed. Ongoing assessment Head tilt-chin lift or jaw thrust Suction if necessary Airway adjunct PPV with O 2 Mechanism of injury present? Yes No Consider manual in-line stabilization Assess mental status Attempted suicide? Assess circulation Transport Airway open? NRB 15 lpm Patient violent? Restrain Assess breathing Assess circulation NRB 15 lpm Rapid medical assessment Altered or unresponsive Alert and able to obey commands No No Yes Yes Yes No Adequate Inadequate Recovery position (no trauma) Position of comfort Focused history and physical exam