This is Steve Carroll and you're listening to the EM Basic Podcast. Today we're going to talk about

altermental status. This is a very broad topic, but we'll boil it down to the important things

that you need to know about how to work up patients with this chief complaint. The differential

for altermental status is a long one and encompasses just about every organ system. What we'll do

today is to go over the broad categories of

altermental status and how to work them up. As always, this podcast doesn't represent the

views or opinions of the Department of Defense, the U.S. Army, or the Shawshack EM residency.

So let's get started where we always start with the vitals. Obviously, each vital size is important,

but temperature is the most important vital sign in patients with alter mental status. A patient with alter mental status and fever puts us down a certain

route right off the bat, so it's important that we recognize fever or even hypothermia in these

patients. So when you're taking the patient's history, you have to find out exactly what is meant

by alter mental status. To some people, this may mean that the patient is lethargic.

To others, it may mean that the patient is acting bizarrely or not acting like themselves.

You need to get as much information from the patient's family members as you can.

Often we deal with patients from nursing homes who are sent in with alter mental status,

but little other information is provided.

We need to find out exactly what the nursing home means by alter mental status.

I admit, it's extremely frustrating when the transfer paperwork doesn't say exactly why they think the patient is altered.

You'll sometimes need to call the nurse at the nursing home and find out what is different about the patient.

You can't start an effective workup without knowing where to begin, so you have to know what someone means by not acting right.

Sometimes the EMS crew will know what the patient's baseline mental status is, so ask them if they're available.

When you're taking a history, ask about any recent trauma or recent illnesses.

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