My partner and I were dispatched for a patient with an altered mental status. As always, my mind started to jump to the different possibilities. As we were enroute, we started to get more information from dispatch. In this case, it was a suspected stroke. My partner and I looked at each other and knew time would be of essence. With strokes, if caught early, the hospital can work towards getting blood flowing normally to the brain again, and perhaps prevent permanent damage.
When we arrived, our colleagues from the fire department were already on scene. They had taken initial vital signs and performed the Cincinnati Stroke Test, which is to discover if the patient has facial droop on one side, slurred speech, and arm drift (all signs that one side of the brain is not getting sufficient blood flow). This patient had all three, so we prepared for immediate transport.
Unfortunately, in this case, we could not confirm the time of the onset of the symptoms. The patient had not been seen for a few days, and therefore we couldn’t establish when he or she was last seen normal. The patient was also not able to confirm when the symptoms had started. We could only get enough information to know that the patient had started feeling poor in the morning, but the patient didn’t call an ambulance. Thus, 911 was not called until someone found the patient in a bad state that afternoon. In this case, the damage may be permanent as a result of not getting immediate care.
The lessons here are:
- It is important to check on people periodically, particularly anyone older than 65
- It’s important for people to call 911 in situations when they don’t feel well, especially if they are suddenly having trouble doing normal tasks. However, the ability to recognize and call for help may be a problem with altered mental patients because they aren’t necessarily thinking clearly to call for help.
Strokes are not the only cause of altered mental states. With the warmer weather, we start to see people experiencing diabetic emergencies where their blood sugar is very low due to working outdoors. When a diabetic spends time outside working and using up blood sugar without eating, he or she may have an emergency that presents itself very similarly to someone who is drunk or on drugs. The person acts agitated, or even belligerent. If someone is acting abnormally, it’s important not to assume that he or she is simply drunk or on drugs.
There are many other potential causes for altered mental status besides diabetic emergencies, strokes, drug abuse and alcoholism. Other causes include brain tumors, heat stroke, seizures, sepsis, shock, infections, dementia, Alzheimer’s, poisoning, lack of oxygen, heart problems, and complications due to medications just to name a few. In addition, mental disorders such as schizophrenia will also cause an altered mental state. In cases of dealing with someone in an altered mental state, it is common for someone to react out of fear and stay away; however, it may be a sign that the person is experiencing a life-threatening emergency. It’s vital that you give that person the benefit of the doubt, consider there may be something going on with them that isn’t easily explained, and call 911.
Joe Bryson, EMT
Wilton Volunteer Ambulance Corps