Chief Complaint: Altered Mental Status
| Pivotal Assessment | Finding | |
|---|---|---|
Level of Consciousness |
Diminished | Not Diminished |
### 1. **History Taking**
- **Patient History**: If the patient is able to provide information, ask about recent events, medical history, medication use, substance use, and any symptoms leading up to the AMS.
- **Collateral History**: Information from family, friends, or caregivers can be invaluable, especially if the patient is unable to communicate effectively.
### 2. **Physical Examination**
- **General Assessment**: Assess the patient’s level of consciousness using scales like the Glasgow Coma Scale (GCS).
- **Neurological Examination**: Evaluate cranial nerves, motor and sensory function, reflexes, and coordination.
- **Vital Signs**: Check blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature.
- **Other Signs**: Look for signs of trauma, infection, dehydration, or systemic illness.
### 3. **Laboratory Tests**
- **Blood Tests**:
- Complete Blood Count (CBC)
- Electrolytes (sodium, potassium, calcium)
- Blood Glucose Level
- Renal Function Tests (BUN, creatinine)
- Liver Function Tests
- Thyroid Function Tests
- Toxicology Screen
- Blood Cultures (if infection is suspected)
- **Urinalysis**: To check for infection or substances.
- **Arterial Blood Gas (ABG)**: To assess acid-base balance and oxygenation.
### 4. **Imaging Studies**
- **Computed Tomography (CT) Scan**: Often the first imaging test to rule out structural abnormalities, hemorrhage, or stroke.
- **Magnetic Resonance Imaging (MRI)**: Provides more detailed images, particularly useful for detecting strokes, tumors, or encephalitis.
- **Chest X-Ray**: To check for respiratory infections or other thoracic conditions.
### 5. **Other Diagnostic Tests**
- **Electroencephalogram (EEG)**: To assess for seizure activity or other electrical abnormalities in the brain.
- **Lumbar Puncture (Spinal Tap)**: To diagnose infections like meningitis or encephalitis, or to measure intracranial pressure.
### 6. **Special Considerations**
- **Medication Review**: Some medications can cause AMS, and reviewing all current medications can identify potential culprits.
- **Substance Use History**: Identifying alcohol or drug use is critical, as intoxication or withdrawal can cause AMS.
- **Psychiatric Evaluation**: In some cases, psychiatric disorders such as severe depression, bipolar disorder, or schizophrenia may present with altered mental status.
### 7. **Differential Diagnosis**
- **Infections**: Meningitis, encephalitis, sepsis.
- **Metabolic and Endocrine Disorders**: Hypoglycemia, hyperglycemia, hyponatremia, hypercalcemia, thyroid disorders.
- **Neurological Conditions**: Stroke, seizure, traumatic brain injury.
- **Toxicologic Causes**: Drug overdose, alcohol intoxication, poisoning.
- **Systemic Illnesses**: Severe dehydration, organ failure.
- **Psychiatric Disorders**: Delirium, dementia, psychosis.
The approach to diagnosing AMS is comprehensive, involving multiple steps to ensure that the underlying cause is accurately identified and appropriately managed.