• Scene – vitals, O2, monitor, CBG
• En route – IV, 12-lead, vitals
• Hospital – labs
• Response to treatment – none
• Disposition – admitted to hospital for high ammonia level of 136
• Eric Boyd, Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Altered mental status
• Hepatic encephalopathy
• UTI
• CVA
• Myocardial infarction
• Drug overdose
• Hypertensive encephalopathy
• Renal failure
• Electrolyte abnormality
• Patient states – nonverbal
• Family states pt went to bed normal and able to perform normal daily activities.
• Pt has been difficult to wake up. She has been in bed all morning and won’t stay awake.
• No recent illness or urinary complaints.
• Family states pt receives multiple transfusions a week (unable to determine why).
• Pt nonverbal and family was unable to give a good Hx.
• Pt was found prone on her bed. She was responsive to pain and withdrew from stimulation.
• Skin: pink, warm, dry, no jaundice noted
• Eyes: pupils fixed at ~ 4mm, no jaundice noted
• Bilateral breath sounds clear and equal
• Moves all extremities, able to raise arms but not hold them up, no facial droop
• Strong smell of urine and feces; incontinence
• CBG- 142
• EKG- NSR
Altered mental status can have many etiologies in the elderly. In this case, the family was unable to provide a good history for the EMS team. Getting a sense of baseline mental status is key, and an understanding of whether the changes are more acute or chronic in nature.
-Dr. David Spiro
• Gender: Female
• Age: 85 years
• Height: Not Available
• Temperature: 97.3 F/36.3 C
• Blood Pressure: 140/52
• Heart Rate: 66
• Respiratory Rate: 16
• Pulse Oximetry: 99% RA
Altered mental status
• PHM: Skin and bladder cancer, hypertension, diabetes, CVA, liver cirrhosis
• Allergies: Sulfa
• Dispatch info: 85 y/o semi-conscious breathing
• Lives at home with family unknown current alcohol use; able to perform normal daily activities.
• List forwarded to ED
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