Assessment of the altered mental status patient

Patients presenting with an altered mental status are a fairly common event for the EMS provider. Much of the uncertainty in etiology and the ambiguity in defining the clinical presentation can be minimized with a good understanding of the common pathology associated with AMS and applying a well-organized, thorough approach to assessing these patients. Recognizing the differences between cognition and arousal and correlating the anatomical functions of the brain to the symptom presentation help considerably in understanding the causes of AMS. Classifying causes as arising from a structural nature or attributing the AMS to either a metabolic or a toxic source are fundamental in understanding potential etiologies. In assessing and reporting clinical findings, it is important to eliminate collective phrases to represent the patient's mental status and, instead, describe the patient's behavior and responses to stimuli. Complying with a standardized approach to assessment and employing effective assessment aids (such as AVPU or SAMPLE) help to prevent omissions of relevant data and contribute to a comprehensive assessment. With these goals in mind, the emergency care provider can effectively assess and manage patients with altered mental status with confidence and precision, and in a comprehensive manner.