Approach to Syncope and Altered Mental Status

MacNeill, Emily; Vashist, Sudhir

doi:10.1016/j.pcl.2013.06.013

Cited by 16 publications

(12 citation statements)

References 54 publications

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“…A full examination focusing on neurological and traumatic findings is important to evaluate for the subtle stroke, seizure, or traumatic brain injury. 1 , 5 , 6 , 8 – 10 …”

Section: Methodsmentioning

confidence: 99%

“… 5 , 6 , 8 , 9 Hypoglycemia is one of the most common causes of AMS in adult patients in the prehospital setting; thus, rapid glucose testing is recommended for patients with AMS. 8 , 10 Upon literature review, other point-of-care tests that have been evaluated for the use of evaluating AMS were 12-lead electrocardiogram (ECG), pulse oxygen (O 2 )-oximetry, pulse carbon monoxide (CO) oximetry, and end-tidal carbon dioxide detection (ETCO 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…Numerous studies demonstrate that seizures are one of the most common causes of AMS. 1 , 6 , 8 – 10 , 60 When a patient exhibits obvious seizures, a seizure protocol will be implemented by paramedics instead of an AMS protocol. It is more challenging to identify prolonged postictal states, non-convulsive status epilepticus (NCSE) and partial seizures, which are all seen more frequently in elderly and pediatric populations.…”

Section: Methodsmentioning

confidence: 99%

“…It is more challenging to identify prolonged postictal states, non-convulsive status epilepticus (NCSE) and partial seizures, which are all seen more frequently in elderly and pediatric populations. 5 , 10 …”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Sanello¹,

Gausche‐Hill²,

Mulkerin³

et al. 2018

WestJEM

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IntroductionIn the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management.ResultsProtocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol.ConclusionProtocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

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“…A full examination focusing on neurological and traumatic findings is important to evaluate for the subtle stroke, seizure, or traumatic brain injury. 1 , 5 , 6 , 8 – 10 …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

Sanello¹,

Gausche‐Hill²,

Mulkerin³

et al. 2018

WestJEM

View full text Add to dashboard Cite

show abstract

“…The most common cause results from temporarily inappropriate cardiovascular reflexes causing vasodilation from a decrease in efferent sympathetic activity. This can extend to bradycardia or even asystole from an increase in vagal discharge and thereby a decrease in arterial BP . This is called neurocardiogenic syncope, although it is commonly referred to as vasovagal, vasodepressor, reflex or neurally mediated syncope .…”

Section: A Rose By Any Other Name…mentioning

confidence: 99%