Focus on assessing and treating the patient's basic life threats before interrogating bystanders or investigating the scene Show
Patients with an altered level of consciousness are among the toughest to assess since there is no classic, "one size fits all" presentation. The clinical presentation is often subtle, which makes recognizing changes in mental status a challenging endeavor. And, the underlying conditions that cause an ALOC have one of the largest differential diagnoses you may encounter in the prehospital setting. Despite the many challenges, EMTs and paramedics who follow a structured approach with these patients are often able to find the cause and rule out worst-case scenarios. When you’re called to help someone who isn’t oriented to time, place or person, here are six ways to facilitate a successful patient contact.
How to use OPQRST as an effective patient assessment toolAssess patient's complaints for associated signs or pertinent negativesRelated featureYes, EMTs diagnose patientsEvery step of the way, at every interaction with a health care provider including EMTs and medics, a diagnosis is made 1. Start with the ABCsAvoid trying to discover the underlying reason for the patient’s ALOC before you do a primary assessment and treat any immediate life threats. If there is a deficit in one of the patient’s ABCs that isn’t the primary cause, it will certainly make the patient worse if left untreated. An unstable airway will lead to hypoxia and central nervous system depression. Inadequate breathing will contribute to high levels of carbon dioxide in the blood and respiratory acidosis. Poor circulation will cause hypoperfusion in the brain. Only after you’ve methodically checked a patient’s ABCs and treated any life threats, should you take a set of vital signs, inquire about the history of the present illness and obtain a SAMPLE history. 2. Do a detailed physical examPerforming a physical exam is often the key to ruling in — or out — a possible cause for a patient’s ALOC. For a stroke, look for a lack of movement on one side of the patient’s body, unequal pupils or the presence of the Babinski’s reflex (the big toe of an adult fanning upwards) by firmly stroking on the sole of the patient's foot with a pen or penlight. Seizure patients may present with oral trauma or incontinence. The skin of patients with hypoglycemia is often pale, cool and clammy. Patients with hyperglycemia often present with hot and dry skin. Look for constricted pupils on patients who have overdosed on opiates and cyanosis in patients who are hypoxic. To search for possible infection sources, scan the patient for signs of dialysis devices and catheters. Always examine the patient to search for trauma and obtain an ECG to make sure a cardiac event isn’t causing the mental status changes. 3. Search for underlying causesAfter you’ve completed a primary assessment, physical exam and obtained a set of vital signs, begin your detective work to find or confirm the underlying cause. An altered mental status is not a disease state in itself, but is always caused by some underlying factor. If the mnemonic AEIOU-TIPS (acidosis, alcohol, epilepsy, infection, overdose, uremia, trauma, tumor, insulin, psychosis, stroke) is difficult to remember on-scene try something different. I use the mnemonic SNOT (stroke, seizure, sugar, narcotics, oxygen, trauma, toxins, telemetry/EKG). This mnemonic is easier for me to remember and lists the most common causes for an altered mental status. 4. Interview multiple sources on sceneSince we can’t obtain reliable historical data from someone with an ALOC, enlist information from family members, friends, caretakers, nursing home workers and witnesses. Begin by asking, "Is this normal for the patient?" which will immediately rule out dementia, Alzheimer’s or other pre-existing conditions that can cause chronic mental status changes. Then, ask what they see different about the patient? Can they describe specifically how the patient is different? When did the change start and what they think might have caused it? Once you have this information, consider it in light of your other findings to discover a possible cause. 5. Assess the environmentEvery time you walk on scene — especially one involving an ALOC patient — take a moment to assess the environment and answer these questions.
Over time, you’ll begin to see a correlation that sometimes exists between the environment and the chief complaint. For example, drug addicts often get high in out-of-the-way places such as bathrooms or vehicles. Alleys are frequently the scene of assaults and someone who has a syncopal event after sitting on the toilet has often had a vagal episode, causing a drop in blood pressure and cerebral perfusion. 6. Treat what you can and follow upAt the end of the day, EMTs and paramedics don’t need to know the exact cause for a patient’s ALOC in the prehospital setting. All we need to do is treat the symptoms we can treat using the tools we have and transport the patient rapidly to the hospital for definitive care. However, don’t fall into the trap of letting the call end when you hand over patient care. Follow up with the ED staff to learn what tests they performed and what they discovered, and keep a journal to document your interesting calls. By keeping the mentality of always being a student and never a master, you will continue to learn and grow throughout your EMS career. Request product info from top EMS Education companies Thank You! By submitting your information, you agree to be contacted by the selected vendor(s) and that the data you submit is exempt from Do Not Sell My Personal Information requests. View our Terms of Service and Privacy Policy. About the authorKevin Grange works as a paramedic with Jackson Hole Fire/EMS and is the author of the new memoir about paramedic school, titled "Lights and Sirens: The Education of a Paramedic." What does the Aeiou tips mnemonic stand for?Noun. AEIOU TIPS (uncountable) (emergency medicine) Initialism of alcohol, epilepsy, insulin, overdose, underdose/uremia, trauma, infection, psychiatric, stroke/shock: reasons why a patient may have an altered mental state.
What does the S in the tips Aeiou mnemonic stand for when considering reasons for altered mental status?If the history and physical examination do not immediately elucidate the cause of AMS, the acronym AEIOU TIPS (Alcohol, Epilepsy/Electrolytes, Insulin/Inborn Errors of Metabolism, Overdose/Oxygen, Uremia, Trauma, Infection, Psychiatric/Poisoning, Stroke/Subarachnoid Hemorrhage (SAH)/Shock) can be used to consider a ...
What does Aeiou tips assess?Search for underlying causes
If the mnemonic AEIOU-TIPS (acidosis, alcohol, epilepsy, infection, overdose, uremia, trauma, tumor, insulin, psychosis, stroke) is difficult to remember on-scene try something different. I use the mnemonic SNOT (stroke, seizure, sugar, narcotics, oxygen, trauma, toxins, telemetry/EKG).
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