Altered Mental Status
Subjective/Objective/
Assessment
Most
patients with acute onset of altered mental state should be seen as P1
Probably
not productive trying to identify a
cause at triage level
Ask
for the onset and duration of altered mental state.
Altered
Mental Status
Semi-critical
Walking
patients slow progression and bedbound patients with poor premorbid functional
status
Quickly
screen for adequate airway, breathing and circulation.
Quickly
look for external head injuries, assess the GCS, screen the pupillary sizes,
and test for lateralised extremity weakness in case this turns out to be due to
head trauma.
Altered
Mental Status
Smells
are useful for screening comatose patients: alcohol, fruity - ketones,
"almonds" - cyanide, fishy-uraemia, fetor
hepaticus, garlic-insecticide.
The
pupils may be large or small in some drug overdoses.
hepaticus, garlic-insecticide.
The
patient may look jaundiced, be pale, or look cyanosed.
Altered
Mental Status
Plan
Dextrostix
is a good screening test for all patients, since hypoglycemia is readily
correctable.
ECG
should be done for all comatose patients.
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