Altered Mental Status

Regulatory Context

Regulatory context for altered mental status includes federal and state requirements. Healthcare facilities must comply with CMS Conditions of Participation, state licensure requirements, and accreditation standards (Joint Commission or AAAHC). Non-compliance can result in citations, fines, or loss of Medicare/Medicaid reimbursement.

Calculation Methods

Dosage calculations related to altered mental status in EMS:

• naloxone: 0.4-2mg IV/IM/IN, titrate to respirations (IV, IM, IN)
• midazolam: 2-5mg IV/IM, 0.2mg/kg IN (IV, IM, IN)
• aspirin: 324mg PO chewed (PO)

Pediatric dosing: always calculate by weight (mg/kg). Use Broselow tape if weight is unknown.

Differential Diagnosis

When assessing altered mental status, use structured assessment tools to differentiate between possible causes:

Glasgow Coma Scale: Components: Eye opening (1-4), Verbal response (1-5), Motor response (1-6). Scoring: 3-15, 8 or less = severe, 9-12 = moderate, 13-15 = mild.

SAMPLE: Components: Signs/symptoms, Allergies, Medications, Past history, Last intake, Events. Scoring: Mnemonic for patient history gathering.

Related Procedures

Procedures related to altered mental status in the EMS setting:

1. Sepsis recognition: qSOFA of 2 or more (altered mentation, RR 22+, SBP 100 or less) then IV fluids 20 mL/kg then early antibiotics if ALS
2. Pediatric weight-based dosing: Broselow tape for length-based weight estimation in emergencies
3. Spinal motion restriction: mechanism + neuro deficit or midline tenderness = full SMR with C-collar and long board