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Medical

ALTERED MENTAL STATUS

Signs and Symptoms: Differential Diagnosis:
• Decreased Mental Status / Coma • Head Trauma
• Bizarre Behavior • Stroke
• Somnolence • CNS Tumor/Mass/Bleed/Infection
• Diaphoresis/Dry, Red Skin • Thyroid Dysfunction
• Polyuria/Polydipsia • Hyperglycemia/Hypoglycemia
• Sweet/Fruity Breath • Diabetic Ketoacidosis
• Altered Respirations • Toxic Exposure
• Signs of Trauma • Environment (Hyperthermia/Hypothermia)
• Fever • Hypoxia
• Psychiatric Disorders
• Seizure Disorder
• Sepsis
Universal Patient Care Guideline Glucose >250?
Continued from: O2 (if Hypoxemic)
IV/IO Guideline
Tactical Evacuation Guideline Cardiac Monitor 1000mL IVF IV
Check Blood Glucose
12-lead ECG
Consider Spinal Immobilization
Glucose <70? Guideline NO Arrhythmia?
Evidence of Alcohol Abuse? <6 60 Blood Glucose 60-250? >250 YES
NO YES Bradycardia Tachycardia
with Pulse
with Pulse
Thiamine 100mg IV/IM YES
Consider Alternate Causes: Cardiac Arrest
Oral Glucose (*See Pearls) (AEIOU-TIP) (VF / Pulseless VT or
OR Asystole / PEA)
50% Dextrose 25g IV or D10 drip

OR Consider: Naloxone 0.4-2mg IV Consider Alternate Causes:
Glucagon 1mg IV/IM • Alcohol/Acidosis

• Epilepsy
Return to Baseline? NO IV 1000mL IVF IV • Insulin
and Improved Unimproved • Overdose
Glucose 60-250? Continuous Monitoring • Uremia/Renal Failure
• Trauma
YES Recheck Glucose: Give additional Fluid Bolus if • Infection
Glucose >250. Be alert for signs of fluid overload.
• Psychosis
Pearls:
• Be aware of AMS as a presentation of environmental exposure/toxins/hazmat – use personal
protection accordingly/decontamination.
• Recheck blood glucose after each intervention.
• *Oral glucose okay if patient alert, protecting airway, and solution available. Proteins+complex
carbs (e.g., sandwich, granola) are better, longer lasting glucose source than simple sugars.
• EKG should be obtained in all suspected toxin or diabetic ketoacidosis cases – evaluate for tall,
peaked T-waves (hyperkalemia) or QRS widening >100ms (toxins).
• Restrain patient as necessary for their safety and crew members safety during flight.
• Glucagon may cause nausea/vomiting–should have anti-emetic prepared.
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