Altered Mental Status Framework

Why This Is Hard

AMS is a symptom, not a diagnosis. The living room looks the same for hypoglycemia, opioid OD, stroke, post-ictal state, sepsis, and head trauma. You need a rapid, repeatable pass that finds fixable causes without tunnel vision.

First Pass (Always)

1. Scene safety / possible trauma or CO / hazardous environment.
2. Airway, breathing, circulation — AMS patients aspirate and obstruct.
3. Glucose early per protocol.
4. SpO₂ and oxygen as indicated; consider EtCO₂ if hypoventilating.
5. Pupils, track marks, med bottles, medical alert jewelry, bystander history.
6. Focal neuro signs → stroke pathway thinking.
7. Fever/hypothermia + infection clues → sepsis thinking.

AEIOU-TIPS Style Map (Education)

• Alcohol / acidosis themes
• Epilepsy / electrolytes / endocrine
• Insulin (hypo/hyperglycemia)
• Opiates / overdose
• Uremia
• Trauma / temperature
• Infection
• Psych / poison
• Stroke / shock / SAH

Use the list to prompt actions you can take now — not as a hospital admission essay.

Key Points for Paramedics

• Treat reversible causes you are authorized to treat (e.g., glucose, naloxone, oxygen) while packaging.
• Do not assume “just drunk” without a full primary survey and glucose.
• Head trauma may be hidden — inspect scalp, ask about falls.
• Document baseline mental status if known (dementia vs acute change).

Field Pitfalls

• Naloxone before airway support planning in severe hypoventilation.
• Missing hypoglycemia because the patient “looks post-ictal.”
• Leaving a patient on the scene who cannot refuse informed consent capacity.

Practice

For three AMS scenarios, list your first five actions in order. Related: Diabetic Emergencies, Naloxone, Stroke.

Sources & Further Study

• EMS AMS educational frameworks; your hypo, OD, stroke, and sepsis protocols.