EMT-Basic Exam: The Basics of Medical Emergencies - Diabetes / Altered Mental State

When a patient’s verbal or nonverbal responses indicate that the patient is unaware of the present situation, he or she may be experiencing an altered mental state. Altered mental status can be a symptom of many conditions. In some cases, you may be able to identify the cause of a patient’s altered mental status, but treating the patient’s symptoms is more important than identifying their cause. Diabetes, seizure, and stroke are common causes of altered mental state.

1. Diabetic Emergency
Altered mental status in a diabetic patient is often an indication of severe illness. When insulin-dependent diabetics miss a meal after taking their insulin or regurgitate their post-insulin meal, they may become hypoglycemic, which means that the body’s blood sugar is too low. Hypoglycemia can result in an altered mental state in which the patient seems intoxicated. Patients may stagger, exhibit slurred speech, or become totally unresponsive. Patients experiencing this form of diabetic emergency may also have an elevated heart rate and cold, clammy skin. More responsive patients may also complain of hunger.
Patients experiencing altered mental status because of a diabetic emergency may need to be treated with oral glucose, which raises blood sugar and can help reverse the patient’s condition. Oral glucose can be administered by EMT-Basics without permission from a medical direction physician in many instances. However, some EMS systems require the EMT-Basic to receive permission from the medical direction physician before administering oral glucose. Oral glucose should not be administered to unresponsive patients or those who are unable to protect their own airway.

2. Seizures
A seizure is defined as a convulsive movement or an altered mental state caused by a random discharge of the brain’s electrical impulses. There are many different types of seizures with various characteristics, including convulsions and episodes in which the patient stares straight ahead. Common causes of seizures include fever, infection, poisoning, hypoglycemia, head trauma, decreased levels of oxygen, and uncontrolled epilepsy.
Following a seizure, some patients may become unresponsive. This is known as a postictal state. This condition occurs after the brain suffers a massive discharge of energy. The postictal state is the body’s attempt to recover from this discharge.
EMTs should encourage seizure patients to seek medical evaluation at the emergency department.

3. Stroke
Strokes occur as a result of the blockage or breakage of brain arteries. Strokes can present with altered mental status, as well as other mental and physical symptoms. Stroke victims may have trouble speaking or may seem confused. It is important to check for other signs of stroke in patients with altered mental status so that proper treatment can be administered.
Other signs of a stroke include sudden weakness or numbness on one side of the body, trouble speaking or seeing, headache, and facial droop.

Tip: Other possible causes of altered mental status include intoxication, infection, head trauma, decreased levels of oxygen, and hypothermia or hyperthermia.

4. Emergency Care of Patients with Altered Mental Status
The most important task while treating a patient with an altered mental status is maintaining a patent (open and unobstructed) airway. Cyanotic patients or patients who are having difficulty breathing on their own may require artificial ventilation. Patient assessment should include investigating the scene for clues to the cause of the patient’s condition as well as a focused history and physical examination.

Related Topics You Should Review:
- Other possible causes of altered mental state
- Common diabetic medications
- Administration of oral glucose