AMS and Psychological AMS and Psychological Emergencies Emergencies Brown University EMS March 4, 2007
May 26, 2015
AMS and Psychological AMS and Psychological EmergenciesEmergencies
Brown University EMSMarch 4, 2007
What is AMS?What is AMS?
Altered mental status: a condition in which the patient displays a change in his/her normal mental state ranging from disorientation to complete unresponsiveness
What Causes AMS?What Causes AMS? Traumatic head injury
Poisoning or drug overdose
Intoxication
Post-seizure
Infection
Shock
Hypoxia
Stroke
Diabetes
Signs and Symptoms: Signs and Symptoms: TraumaTrauma
Obvious trauma (DCAP-BTLS)
Abnormal respirations
Abnormal heart rate
Unequal or sluggish pupils
Hypo/hypertension
Pale, cool, moist skin
Posturing
Raccoon eyes (late sign)
Battle’s signs (late sign)
Signs and Symptoms: Signs and Symptoms: MedicalMedical
Abnormal respirations
Abnormal heart rate
Abnormal skin condition
Unequal or sluggish pupils
Stiff neck
Seizure activity
Hypertension and bradycardia
Bowel/bladder incontinence
Irregular blood glucose level
Signs and Symptoms: Signs and Symptoms: DiabetesDiabetes
Irregular blood glucose level:
Hypoglycemia (<60mg/dl w.signs; <50mg/dl w/o signs)
Hyperglycemia (>120mg/dl)
Seizure activity
Stroke-like symptoms
Combativeness or bizarre behavior
Anxiousness/restlessness
Rapid AMS onset
Intoxicated appearance
Tachycardia
Cool, moist skin
Hunger
Signs and Symptoms: Signs and Symptoms: IntoxicationIntoxication
25% of calls at Brown!
Symptoms depend on class of drugs
CNS Stimulants
CNS Depressants
Narcotics
Hallucinogens
Volatile Inhalants
AssessmentAssessment Initial assessment:
Stabilize c-spine if trauma cannot be ruled out
ABCs
SAMPLE history
Baseline vital signs
Include blood glucose
Physical exam:
Head and pupils
Mouth and oral mucosa
Chest and breath sounds
Abdomen, extremities, posterior
Assessment (cont’d)Assessment (cont’d) Check the scene for evidence of:
Rx or OTC medication (including insulin)
Drug or alcohol abuse
Oxygen tanks
Unusual odors (gas, poisons)
Transport decision:
Patients with AMS fall under implied consent and must be transported
Behavioral EmergencyBehavioral Emergency A situation in which a person may
exhibit panic, agitation, or bizarre thinking or actions
Examples of psychological emergencies:
Anxiety
Phobias
Depression
Bipolar disorder
Paranoia
Schizophrenia
Suicidal ideations
Causes of Behavioral Causes of Behavioral ChangesChanges
Abuse/traumatic event
Traumatic head injury
Poisoning or drug overdose
Infection
Shock
Hypoxia
Stroke
Diabetes
Excessive heat/cold
Psych vs. AMSPsych vs. AMS
AMS
Sudden onset
Visual hallucinations
CAOx<3
Abnormal pupils
Excessive salivation
Incontinence
Psych
Gradual onset
Auditory/visual hallucinations
CAOx3
PEARRL
AssessmentAssessment Initial assessment
SAMPLE history
Baseline vital signs
Physical exam
Be sure to rule out a physical emergency!
Keep In Mind…Keep In Mind… Emotional injury is just as real as physical
injury
Speak calmly and be reassuring
Maintain a comfortable distance
Maintain eye contact
Respond honestly
Never threaten or challenge the patient
Do not play into hallucinations
Do not touch the patient without his/her consent
Never leave the patient alone