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Altered Mental Status, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Dysfunction in either the reticular activating system in the upper brainstem or a large area of 1 or both cerebral hemispheres

  • Definitions:

    • Confusion: A behavioral state of reduced men...

Diagnosis

Signs and Symptoms

Confusion 
  • Difficulty in maintaining a coherent stream of thinking and mental performance:

    • Remember to consider level of education, language, and possible learning disabiliti...

Treatment

Pre-Hospital

  • Airway management if loss of airway patency

  • IV access, supplemental oxygen, cardiac monitor

  • Spine immobilization if possibility of trauma

  • “Coma cocktail”:

  • Loo...

Follow-Up

Disposition

Admission Criteria

All patients with acute and persistent changes in mental status require admission. 

Discharge Criteria

  • Treated hypoglycemia related to insulin therapy with resolve...

Pearls and Pitfalls

  • Consider reversible causes

  • Consider head CT for any patient with...

Additional Reading

  • Kanich  W, Brady  WJ, Huff  JS, et al. Altered mental status: evaluation and etiology in the ED. Am J Emerg Med.  2002;20:613–617.

  • Sporer  K, Solares  M, Durant  E, et al. Accur...

Codes

ICD9

  • 298.9 Unspecified psychosis

  • 780.97 Altered mental status

ICD10

  • R41.0 Disorientation, unspecified

  • R41.82 Altered mental status, unspecified

SNOMED

  • 419284004 altered mental status (finding)

  • 40917007 ...

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