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