Inadequate ventilation will lead to elevated levels of CO2 (respiratory acidosis) and can cause AMS. Hypoxia is a potentially reversible cause of AMS. Are there secretions or vomit that needs to be suctioned? Open the airway, check pulse-oximetry and provide supplemental oxygen if needed. Airway: Check to see that the airway is open and is being protected.Ideally this should happen as the patient is being placed on a monitor and IV access is being established. The “ABCDEF approach” provides a good opportunity to check for quickly reversible causes of AMS. Plan the disposition of a patient with AMSĪll emergency department patients require an initial assessment for immediate threats.Formulate an initial management of many causes of AMS.Construct an approach to the diagnostic workup and management of a patient with AMS.List a differential diagnosis for AMS based on history and physical findings.Identify the three most common classifications of AMS.Recognize the importance of historical factors in diagnosing causes of AMS.Upon completion of this self-study module, you should be able to: Developing a structured and systematic approach to these cases will help you develop and streamline the diagnostic workup and management of these patients with AMS. Causes run the gamut from easily reversible (hypoglycemia) to permanent (intracranial hemorrhage) and from the relatively benign (alcohol intoxication) to life threatening (meningitis or encephalitis). Enlisting historical data from multiple sources and maintaining a high index of suspicion is necessary to detect the behavioral marker of potentially catastrophic pathology.Īltered mental status (AMS) is not a disease: it is a symptom. At times the clinical picture is more subtle and not easily identified. Some presentations are clear a patient who is postictal after a seizure or a diabetic patient who is hypoglycemic. A quick review of the EMS sheet and nursing home paperwork show a history of diabetes, multi-infarct dementia, schizoaffective disorder, seizure disorder and chronic abdominal pain.ĭiagnosing a patient with a change in mental status can be a daunting challenge in the Emergency Department (ED). She’s 87 years old, bed-bound and minimally verbal. The nurse lets you know about the new patient that was just sent over from the local nursing home with a chief complaint of “AMS”. SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education GrantĬareer Development and Mentorship CommitteeĬommunications and Social Media Committee
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