Severe liver disease, altered mental status – Paramedic student assessment


• IV access Disposition
• Transport to nearest facility


Elliot Williams, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Altered mental status

Differential Diagnosis

• Psychiatric crisis
• Hyper-ammonemia
• Stroke/CVA
• Hyperglycemia (DKA)
• Hypoglycemia
• Dehydration
• Electrolyte abnormalities
• Sepsis/Bacterial infection/Lactic acidosis
• Acute coronary syndrome
• Arrythmia
• HIV dementia

Patient Workup

• GBG = 156
• Vitals

Editor’s Notes

“The scene seemed calm and under control which is an important tone to set. The student seems a little disorganized in his approach. I liked his interaction style with the patient initially but again he allowed himself to be distracted from tasks. The student also needs to stop touching his face with his gloves.”

– David Tauber, Paramedic Program Director, Yale New Haven Hospital Sponsor Hospital Progr

Suggested References

Assessing altered mental status


• Gender: Male
• Age: 58 years
• Height: Not Available
• Weight: Not Available


• Temperature: Not Available
• Blood Pressure: 169/87
• Heart Rate: 64
• Respiratory Rate: 12
• Pulse Oximetry: 100% RA

Signs and Symptoms

Altered mental status with confusion.

History Medical

• Cirrhosis of the liver
• Glaucoma
• Diabetes
• Hernia Social
• Lives in adult foster facility


• Lactulose
• Insulin

Related videos