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


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


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


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

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

S Stroke


Hemorrhagic stroke, subarachnoid hemorrhage - perform a FAST scan

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

Documentation[edit | edit source]

Documentation of Altered Mental Status should be included in the Patient Care Report (PCR) in the form:

  • Pertinent positives and negatives should be included in a narrative. Example: "Patient has history of diabetes with poor compliance with medications. Patient BSL 820 mg/dL. Patient is obtunded AxO 2 normally AxO 4. Patient exhibits eupnea with no acetone breath odor. Patient's mother states that patient has recently been experiencing polydipsia, polyuria, and diuresis. Per mother, patient has been noncompliant with medications for x2 weeks. GFAST negative, 12 lead negative for ST elevation."

Self Assessment[edit | edit source]

OOjs UI icon lightbulb.svg
  • Use the AEIOUTIPS 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
  • Test your knowledge with this quiz

Tips and Tricks[edit | edit source]

  • Even if you find a viable reason for your patient to be altered, keep checking for other possible causes. There have been many cases where an EMS crew has transported Code 3 stroke alert for a patient whose blood glucose levels were low. Similar cases have been seen where a frequent flier with an ETOH abuse history is written off as drunk despite having a life threatening brain bleed.

Additional Resources[edit | edit source]

TBD - extra videos to watch, links to other pages for more reading

FA info icon.svg Angle down icon.svg Page data
Keywords trauma
SDG SDG03 Good health and well-being
Authors Catherine Mohr
License CC-BY-SA-4.0
Language English (en)
Translations Spanish, Chinese
Related 2 subpages, 20 pages link here
Impact 3,499 page views
Created November 5, 2020 by Emilio Velis
Modified May 25, 2023 by Felipe Schenone
Cookies help us deliver our services. By using our services, you agree to our use of cookies.