Medical Patient Assessment for Altered Mental Status (AEIOUTIPS)

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About this medical skill
Parent skills Medical Patient Assessment
Video annotations Click on a timestamp to navigate through the video.
Self-assessment
Use the acronym and practice asking the relevant questions to determine the patient's likelihood of exposure to the altering agent until comfortable with the work flow
Equipment and materials
PPE
EMS Jump Bag
Oxygen tank with regulator
More video data

For patient's without immediate threats to life, diagnosing a patient with a change in mental status can be a daunting challenge in the prehospital setting as the sources of Altered Mental Status (AMS) can be many and varied. It is important to remember that AMS itself is not a disease, it is a symptom of an underlying pathology. Causes run the gamut from easily reversible in the field such as hypoglycemia to situations like stroke that require immediate recognition and rapid transport. Differentiating the relatively benign from the life threatening can be a real challenge as the differential diagnoses are enormous.

SAMPLE History[edit | edit source]

AEIOU-TIPS is a mnemonic acronym used by many medical professionals to recall the possible causes for altered mental status, and there are many versions. Below is the version typically used in prehospital EMS which includes the Symptoms, Medications and Pertinent Medical History elements of the SAMPLE History. Keeping a structured and systematic approach to these cases will help you develop and streamline the diagnostic workup and management of these patients with AMS.

Mnemonic component Examples and questions to ask
A Alcohol Alcohol or drug intoxication - observe behavior, note smell of alcohol if any, ask about consumption
E Epilepsy

Electrolytes

Endocrine

Epileptic seizure (or seizure for any other reason) - look for signs, ask about history

Hyponatremia; hypernatremia; hypocalcemia; hypercalcemia - ask about history of vomiting or dehydration

Adrenal insufficiency; thyroid disease - ask in history

I Insulin Hypoglycemia; hyperosmolar hyperglycemic state; ketoacidosis - ask about history of diabetes, test blood glucose, note smell of breath
O Overdose Prescription or non-prescription drug overdose - ask about medications or other drug use, look for signs of field reversible overdoses such as opioid
U Underdose

Uremia

Insufficient dose of prescription medications - ask what medications the patient is on, and whether they were taken that day

Excess urea in the blood due to kidney failure or urinary obstruction - ask about history of kidney failure, look for shunts

T Trauma

Temperature

Concussion; traumatic brain injury; increased intracranial pressure due to epidural hemorrhage - ask about falls

Hypothermia or Hyperthermia - take temperature during vital signs

I Infection Encephalitis, meningitis, meningoencephalitis; sepsis - note fever, ask about headache, infectious history
P Poisons

Psychogenic

Carbon monoxide poisoning; lead poisoning; iron poisoning - ingestion history

Psychosis; pseudoseizure; conversion disorder - ask about history of mental illness

S Stroke

Shock

Hemorrhagic stroke, subarachnoid hemorrhage - perform a FAST scan

Hypoperfusion due to cardiogenic, neurogenic, or other forms of shock - Assess for signs of shock