Overview

Question 1

Introduction

Answer 1

Mental status involves awareness (or level of consciousness), cognition (or thinking) and attention.
A typical altered pt may be sleepy, not making sense or unable to follow commands.

Pt may also be excited, repetitively asking questions or belligerent.

Acute confusion or delirium is defined as acute dysfunction secondary to a medical condition.
It is important to understand the difference between dementia, psychosis and delirium

Question 2

Dementia

Answer 2

is a cognitive decline from an organic cause that occurs in a steady, progressive fashion.
Alzheimer’s disease is one type of dementia. Dementia does not change hour to hour

Question 3

Psychosis

Answer 3

involve hallucinations and/or delusions but the pt is usually oriented and aware of his/her surroundings

Question 4

Delirium

Answer 4

is a confusional state that represents an acute change from the pts baseline.
The pt is disoriented and sometimes unaware of his/her surroundings.
The pt’s mental status can wax and wane over minutes or hours

Because it may be the result of a reversible medical problem, delirium is a sign of an acute medical emergency that requires aggressive diagnostics and treatment.

Acute delirium can co-exist in a pt w/ underlying dementia or psychosis

Question 5

Guiding Principles

Answer 5

Only a few causes of altered mental status can be treated in the field, however for all pts the fundamental principles is
airway and oxygenation which may improve outcomes

Pt history and assessment are vital in determining the presence of a treatable cause particularly w/ respect to symptomatic hypoglycaemia or poisoning and overdose.

Paramedics should treat pt in accordance w/ their treatment guidelines for the specific pt presentation

All pts w/ ALOC should have a BGL check

pts w/ ALOC and no discernable treatable cause require expeditios transport to hospital for further diagnostic and treatment

Question 6

Causes - Hypoxia

Answer 6

Airway obstruction, COPD/Asthma, pneumonia, pulmonary edema, pulmonary embolus (PE), pneumothorax, hemothorax, and pulmonary contusions, CO poisoning

Question 7

Causes - Acute Metabolic Disturbances

Answer 7

Hypo/Hyperglycaemia, electrolyte imbalances, renal failure and hepatic failure, hyperglycaemic hyperosmolar nonketotic syndrome (HHNS)

Question 8

Causes - Environmental

Answer 8

Hypothermia, Hyperthermia

Question 9

Causes - Acute Vascular

Answer 9

Stroke, subarachnoid haemorrhage (SAH), hypertensive crisis, CNS infections including menigitis, encephalitis and intracerebral abscess

Question 10

Causes -Alcohol (ETOH)

Answer 10

ETOH intoxication or withdrawal

Question 11

Causes - Toxins

Answer 11

Alcohols, over the counter medication, prescription or recreational drugs, insecticides or pesticides, animal venoms

Question 12

Causes - Withdrawal

Answer 12

Withdrawal is the bodys reaction to the sudden cessation of a prolonged usage of a substance

Common are withdrawal from alcohol, opiates barbiturates and benzodiazepines

Question 13

Causes - Endocrinoogical Disorder

Answer 13

Endocrinological causes of confusion include thyroid storm myxdema coma, Addisons crisis, hyper/hypoglycaemia

Question 14

Causes - Heavy Metals

Answer 14

Mercury and Lead

Question 15

Causes - Behavioural

Answer 15

Psychotic or catatonic states

Question 16

Causes - Post Seizure State

Answer 16

New or pre-existing seizure disorder