Altered Consciousness and Behavior

Altered Consciousness and Behavior

Andrew Bissonette

Joseph B. Miller


Patients presenting with altered mental status (AMS) to the emergency department (ED) are common and challenging. Although etiologies for AMS include benign diagnoses, such as alcohol intoxication, many are associated with the potential for negative outcomes and require immediate stabilizing or life-saving interventions. Once rapidly reversible life threats are addressed, there often remains a broad differential diagnosis to consider requiring a systematic approach, including a careful history and neurologic examination, and judicious use of diagnostic tools.


AMS in the prehospital setting is often associated with life-threatening conditions that require emergent interventions, such as hypoglycemia, hypoxemia, seizures, or opiate overdose. A brief history and examination focused on life threats is indicated. History should focus on pertinent information from witnesses and environmental observations. Time course and prodromal symptoms are tremendously useful, as is information about the patient’s medical history, medications, and any substance abuse or recent illness.2

Physical examination should focus on vital signs, oxygen saturation, signs of trauma, and a standardized assessment of alertness, such as the Glasgow Coma Scale (GCS). Although the GCS
was derived for assessment of head injury, it is a reasonable means of documenting changes in mentation due to any etiology. Critical tests in the field include glucose level and stroke screen if clinical suspicion warrants. All patients with AMS should be placed on a cardiac monitor with pulse oximetry. Treatment should be administered in the prehospital setting, according to local protocols for the suspected etiology. Figure 6.1 shows a checklist of prehospital considerations most relevant to the management of patients with AMS.

Jun 23, 2022 | Posted by in EMERGENCY MEDICINE | Comments Off on Altered Consciousness and Behavior

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