Podcast: Play in new window | Download

Mnemonic: AEIOU-TIPS

Step 1: Evaluate the Airway

  • General principles
    • “If they can’t speak, they can’t control their airway”
    • “If GCS is <8, intubate”
  • In the real world, it’s a clinical judgement call
    • Postictal patients?
    • Intoxicated patients?

Step 2: Point of Care Labs

  • Finger stick blood glucose
  • EKG
    • Dysrhythmia?
    • Ischemia?
    • Abnormal intervals?
  • Pregnancy test

Step 3: Consider Naloxone

  • Classic dose – 0.4 to 2mg IV/IM
    • Many start with lower doses to lower chance of severe withdrawal
  • Can also be given intranasal (2-4mg)

Step 4: Consider Differential Diagnosis

  • Mnemonic: AEIOU-TIPS
    • *Note: You don’t need to order all of these tests on every patient with altered mental status!!!
  • Alcohol
    • Blood alcohol level
    • Thiamine
  • Endocrine/Electrolytes
    • Includes
      • Hypoglycemia
      • Hepatic encephalopathy
      • Myxedema coma
      • Hyponatremia
    • Obtain
      • Electrolyte panel
      • Hepatic panel
      • TSH
      • Ammonia
  • Ischemia (Cardiac)
    • EKG
    • Troponin
  • Opiates
  • Uremia
  • Trauma
    • CT head without contrast
    • CT cervical spine without contrast
  • Infection
    • Urinalysis
    • Chest x-ray
    • Lumbar puncture
    • CBC
    • Lactic acid
    • Blood cultures
  • Poisoning
  • Stroke
    • CT head without contrast
    • Neuro exam for focal deficits

Additional Reading