Altered LOC and Prudent questions for the EMT-B

[Juilin]

In the field, what are the first few questions for an altered patient that go through your head. I was once told by a nurse, opiates, diabetes, and it might of been hypoxemia (cant remember). What are the most prudent considerations and thus questions for the EMT-B to ask.

As a caveat, I say all of this knowing that my protocol for any altered patient is immediate transport. I just find that I learn alot from these kind of discussions and the differnt approaches everyone has.

[hfdff422]

For B's, our primary concerns are going to be diabetes, ETOH/narcotics, and hypoxemia. We can treat two of those (depending on the situation and protocols, etc.) and the other we need to know for personal safety. But as B's, we can only do baseline assesments and treat with O2 and diesel, so it is unlikely that we will be able to determine any other problems and even less likely be able to treat it. *****NEVER FORGET TO RULE OUT TRAUMA****** Even if the scene is safe and there are no apparent signs of trauma, do assesments as necessary to rule out trauma. Something to consider is hypovolemia, as internal bleeds are more common than you may think in older patients. Drug interactions also, make sure to get all medications and take them with you when the patient has more than one prescription- especially if one is new.

[Ace844]

In the field, what are the first few questions for an altered patient that go through your head. I was once told by a nurse, opiates, diabetes, and it might of been hypoxemia (cant remember). What are the most prudent considerations and thus questions for the EMT-B to ask.

As a caveat, I say all of this knowing that my protocol for any altered patient is immediate transport. I just find that I learn alot from these kind of discussions and the differnt approaches everyone has.

"Juilin,"

Can you please be abit more specific with your question as it's a bit muddled in your post. At first you ask about assessment questions and what we ask our pt's, then there's some confusing non-sense about nurses stating crap....or err;

"I was once told by a nurse, opiates, diabetes, and it might of been hypoxemia (cant remember)."

whatever that means...Please clarify..??!!

out here,

ACE844

[Ridryder 911]

Altered level of consciousness, can occur from several reasons. Yes, trauma is one of the major causes. Medically, any changes in cerebral blood flow.. CVA, inner cranial head bleeds, diabetes (hyper/hypoglycemia), electrolyte imbalances, poor oxygenation (hypoxia), as well as poor cardiac functions, and even senility. Other conditions such as drug and substance abuse ( which medical problems can be combined with this, can occur as well).

I have as yet read any journal or text that describes using "diesel" on any treatment or patient. Expedite and not delay, but giving the impression that "high tailing" to the hospital .. so many get the impression and actually "speed' back to the hospital is wrong. Again, it has been proven you are going to save only about 3-4 minutes total.

Providing an ensure appropriate airway (positioning, possible NP or OP) airway, and oxygenation, caution on oxygenation lots of head injury patients have "projectile vomiting".. so cannula may want be utilized as well.

R/R 911

[Ace844]

For B's, our primary concerns are going to be diabetes, ETOH/narcotics, and hypoxemia. We can treat two of those (depending on the situation and protocols, etc.) and the other we need to know for personal safety. But as B's, we can only do baseline assesments and treat with O2 and diesel, so it is unlikely that we will be able to determine any other problems and even less likely be able to treat it. *****NEVER FORGET TO RULE OUT TRAUMA******

I disgree, there is alot you can do assessment wise even as a Basic if your willing to educate yourself to do so. PART OF YOUR DUTY AS A BLS CLINICIAN IS: to ensure scen safety [ yes, I know you mentioned that below], perform a complete and thorough assessment ***{This is perhaps the most important function any providerat any level performs period WITHOUT THIS YOU HAVE NOTHING!!!}***, determine when your pt is sick enough to warrant ALS care and the appropriate facility to transport them to, TREATMENT, and many others...

Even if the scene is safe and there are no apparent signs of trauma, do assesments as necessary to rule out trauma.

Your assessment serves a purpose, and function WAY BEYOND JUST TRYING TO FIND OUT IF YOUR PT SUFFERED TRAUMA!!!! :shock: :!: :!: :!:

Something to consider is hypovolemia, as internal bleeds are more common than you may think in older patients. Drug interactions also, make sure to get all medications and take them with you when the patient has more than one prescription- especially if one is new.

Good point...

Out here,

ACE844

[Juilin]

"Juilin,"

Can you please be abit more specific with your question as it's a bit muddled in your post. At first you ask about assessment questions and what we ask our pt's, then there's some confusing non-sense about nurses stating crap....or err;

whatever that means...Please clarify..??!!

out here,

ACE844

I apologize for my non-sensical muttering. I was simply trying to convey that I was told some of the most prudent, or easily questioned, concerns for an EMT-B when approaching an altered LOC situation are opiatenarcotic use, diabetes, and hypoxemia.

My question was then, what are your most prudent concerns. Another way of phrasing it, what questions immediately come to mind. I suppose I should have clarified that these questions were meant to be a part of history gathering.

Sorry if its overly simply, I've been doing this for less than a year. Just trying to make some conversation. :?

[ptemt]

We were taught to consider AEIOU TIPS

Alcohol

Epilepsy

Insulin

Overdose

Underdose

Trauma

Infection

Psych

Stroke

[AZCEP]

We were taught to consider AEIOU TIPS

Alcohol

Epilepsy

Insulin

Overdose

Underdose

Trauma

Infection

Psych

Stroke

Wow, 6 replies before it got mentioned.

Let me first agree with Rid and Ace. If you don't do a good assessment, why did you bother showing up on scene. Having some idea of your ability to treat is based almost entirely on your ability to perform an adequate/thorough assessment. You may not be able to treat anything that you find, but if you don't find anything you aren't going to do any treatment anyway.

The "vowel tips" mentioned above is a good start, but forgets a couple things.

A-lcohol

-pnea

-rrythmia

-naphylaxis

E-pilepsy

-nvironmental

I-nsulin

O-verdose

U-remia

-nderdose

T-rauma

I-nfection

P-oisoning

-sychogenic

S-troke

-hock

If you are going to use a mnemonic, it can be helpful, but remember that when you find a cause under "A" that doesn't mean that you get to stop there. You can also use O-P-Q-R-S-T, and you probably should.

[Asysin2leads]

These are all some good suggestions, but, as my usual caveat, garner as much information on scene as you can, in a timely manner, but don't lose sight of the fact that except for perhaps hypoglycemia who is able to follow directions, advanced medical or surgical intervention is the only thing that is going to help these people. In other words, get them to a hospital, ASAP, and remember, oxygen, oxygen, oxygen, ALS intercept if necessary. Don't play around with people's brains.

Rule out psych history, diabetes, hypoxia (if the person is hypoxic to the point of being AMS, its probably going to be fairly obvious), CVA, ETOH (do the smell drunk?), Narcotics, head injury, hypovolemia (blood pressure), sepsis (have they been sick for a while? Do they have a fever?), there's probably a few others I'm not thinking of. All AMS is caused by the same thing, lack of oxygen to the brain, its what is causing the lack of oxygen that's important.

[Ace844]

I apologize for my non-sensical muttering. I was simply trying to convey that I was told some of the most prudent, or easily questioned, concerns for an EMT-B when approaching an altered LOC situation are opiatenarcotic use, diabetes, and hypoxemia.

My question was then, what are your most prudent concerns. Another way of phrasing it, what questions immediately come to mind. I suppose I should have clarified that these questions were meant to be a part of history gathering.

Sorry if its overly simply, I've been doing this for less than a year. Just trying to make some conversation. :?

"Juilin,"

No worries, you're learning, and because I was confused thats why i asked for clarification. Now again, maybe it's just me but It seems like your asking for assesment questions, yet it also could be construed that your asking for the potential DDX considerations. Since I'm not sure what you want I'll try to help with both.

You can get a general idea of what I mean here in these web pages, the last one should be the most helpful to you;:

[web:74f5a1395a]http://www.geocities.com/CollegePark/Union/5092/mnemclin.html[/web:74f5a1395a]

[web:74f5a1395a]http://www.im.org/AAIM/Pubs/Docs/CDIMCurriculumGuide/AchievingCoreCompetencies/AlteredMentalStatus.htm[/web:74f5a1395a]

[web:74f5a1395a]http://www.eric.vcu.edu/pub/ACP/LetsingerACP06.pdf[/web:74f5a1395a]

[web:74f5a1395a]http://jaapa.com/issues/j20050201/articles/alteredmental0205.htm[/web:74f5a1395a]

[web:74f5a1395a]http://members.aapa.org/aapaconf2005/syllabus/5006Statler.pdf[/web:74f5a1395a]

Next as far as specific assessment questions which you will ask, these are quite variable based on presentation, availability of bystanders who know the pt, available PMH & baseline info. etc.. The most glaringly obvious are those which should already be integrated into your BLS assessment. SAMPLE, AVPU, HPI, etc...These will be needed to help determine acute vs chronic vs organic vs extra causes, etc... In short you posted a braod question so you got a broad answer from Rid and the others here. If you have something abit more specific, perhaps at that point we'll be able to better answer your inquiry and questions.

hope this helps,

ACE844