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

The Western Journal of Emergency Medicine
Ashley SanelloGregory H Gilbert

Abstract

In 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. We 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. Protocols 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 nalo...Continue Reading

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Citations

Jul 30, 2020·The Western Journal of Emergency Medicine·Sammy S HodrogeGregory H Gilbert
Apr 15, 2020·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Seth TurnerChristian Martin-Gill
May 15, 2020·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Anssi SaviluotoJouni Nurmi
Jan 14, 2021·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Maximilian LutzWolf Ulrich Schmidt
Nov 5, 2020·Journal of the American College of Emergency Physicians Open·Tabitha ChengJ Joelle Donofrio-Odmann
Aug 25, 2021·Prehospital and Disaster Medicine·Colin JenkinsMarc Eckstein

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