Overview
This lecture covers a systematic approach to assessing patients with altered mental status, introducing key mnemonics to guide paramedics through essential differential diagnoses and interventions.
Assessment Mnemonics for Altered Mental Status
Evans's 3 S's Mnemonic
- The three primary causes to consider are Stroke, Sepsis, and Sugar (hypo/hyperglycemia).
- For stroke, perform a stroke scale assessment.
- For sepsis, look for fever, tachycardia, and hypotension; common infection sources are pneumonia and urinary tract infection (UTI).
- For sugar, check the patient's blood glucose level.
- An additional "bonus S": Seizure—consider seizure activity or history, including possible causes like alcoholism.
N-O-T Mnemonic
- N stands for Narcan—consider opiate or other drug overdoses and toxic emergencies.
- O stands for Oxygen—assess for hypoxia; give supplemental oxygen if SpO2 is below 94%.
- T stands for Trauma—look for signs of hidden trauma, such as head injury or internal bleeding, especially if not obvious on initial exam.
Clinical Decision Steps
- If all assessments (vital signs, glucose, stroke scale, physical exam) are normal, consider internal or metabolic causes requiring hospital evaluation.
- Early identification and communication with the hospital are crucial for life-threatening conditions.
Key Terms & Definitions
- Altered Mental Status — Any change in a patient’s level of consciousness or cognitive function.
- Stroke — Loss of brain function due to interrupted blood supply, assessed with stroke scales.
- Sepsis — Life-threatening organ dysfunction from an overwhelming infection, often with fever, tachycardia, and hypotension.
- Hypoglycemia/Hyperglycemia — Abnormally low or high blood glucose levels affecting mental status.
- Seizure — Sudden, uncontrolled electrical disturbance in the brain, potentially causing confusion or altered consciousness.
- Narcan (Naloxone) — Medication used to reverse opioid overdoses.
- Hypoxia — Low blood oxygen level, causes confusion and other symptoms.
- Trauma — Physical injury that may not be apparent, including internal bleeding or head injury.
Action Items / Next Steps
- Practice using the "3 S's" and "N-O-T" mnemonics during patient assessments.
- Review common sources and signs of infection, stroke, and trauma.
- Ensure competence with vital sign measurement and glucose checks.
- Prepare for possible scenarios involving overdose, hypoxia, or hidden trauma.