Altered mental status is any change in a person's level of awareness or thinking, from mild confusion to coma. Causes include low blood sugar, low oxygen, stroke, overdose, infection and head injury, and many can be reversed quickly if found early.
Key symptoms
- Confusion, drowsiness or new strange behavior
- Not knowing time, place or people
- Slurred speech or weakness on one side
- Headache, fever, seizure or recent fall
- History of diabetes, drug or alcohol use
What you find on exam
- Airway, breathing and circulation first
- Glasgow Coma Scale or AVPU
- Pupils, stroke signs (BE-FAST) and signs of head trauma
- Skin: temperature, sweat, rash, needle marks
- Clues on scene: pill bottles, medical alert ID
Tests
- Blood glucose right away
- Oxygen saturation, waveform capnography and temperature
- 12-lead ECG and cardiac monitor
- In the hospital: head CT, electrolytes, blood count, toxicology
Treatment basics
- Support airway and breathing; oxygen if saturation is low
- Dextrose or glucagon for low blood sugar
- Naloxone for suspected opioid overdose with slow breathing
- Stroke alert and rapid transport to a stroke center if signs of stroke
- Treat seizures, fever and other causes found
Red flags
- GCS 8 or less or unable to protect the airway
- New one-sided weakness or speech problems
- Fever with stiff neck or a purple rash
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021); NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.