Approach to a Patient with Altered Mental Status

The evaluation of a patient with altered mental status begins with a detailed history. Because the patient may be unable to offer a history, it will be required to seek additional information from family, friends, or the primary medical team. The first step is to ascertain the timing of the mental status change and the circumstances surrounding it, such as medication/drug usage or trauma. An acute change in mental state is a medical emergency that necessitates an immediate, systematic evaluation. Airway, breathing, and circulation (“ABC’s”) should be evaluated in conjunction with an updated set of full vital signs and finger-stick blood glucose. Tachycardia may indicate a systemic infection, pulmonary embolism, or atrial fibrillation with high ventricular rate.