Altered Mental Status in the Emergency Department

Abstract

Altered mental status is an umbrella term that covers a broad spectrum of disease processes that vary greatly in chronicity and severity. Causes can be a primary neurologic insult or a result of a systemic illness resulting in end-organ dysfunction of the brain. Acute changes in mental status are more likely than chronic changes to be immediately life-threatening and are therefore the focus of this review. Given the potential time-sensitive nature, acute changes in mental status must be addressed immediately and with urgency. We recommend a primary survey followed by a secondary survey with special attention to immediate life-threatening reversible causes. We then recommend a systems-based approach searching for any other life-threatening or reversible causes. Because the differential for altered mental status is broad, a comprehensive emergency department evaluation including a detailed history and physical exam as well as laboratory and radiographic testing is needed.

Neurological symptoms in Covid‐19 patients in the emergency department

“…Anosmia is associated with some viral infections, such as rhinovirus, picornavirus, parainfluenza, Epstein‐Barr virus, or other human coronaviruses (Suzuki et al., 2007). Altered mental status could be related with the presence of hypercapnia, acute kidney injury, acute liver failure, fever, drugs, or even the viremia (Smith & Han, 2019; Ward et al., 2020). In our sample, it seemed to predict a more severe presentation, as it was an independent predictor of mortality (Ward et al., 2020).…”

“…We systematically analyzed the presence of neurological symptoms, including anosmia/hyposmia, altered mental status (Smith & Han, 2019), headache, myalgia, syncope, seizures, acute sudden focal symptoms (paresis, hypoesthesia, ataxia, and speech disorders), vertigo, and others. We focused on symptoms because at the moment of ED presentation, the cause of the symptoms may not be clear yet.…”

Not Everything Requires a Psychiatry Consult: Subdural Hematoma as a Cause of Transient Acute Quadriplegia

“…Altered mental status is a very broad term that includes, but is not limited to, confusion, strange behavior, lethargy, agitation, psychosis, disorientation, and hallucination [15]. These are particularly alarming when they are acute manifestations as they are considered more likely to represent life-threatening conditions [16]. The etiology of altered mental status is not always psychiatric in nature, meaning a psychiatry consult is infrequently sufficient and may not even be required [15].…”

“…The etiology of altered mental status is not always psychiatric in nature, meaning a psychiatry consult is infrequently sufficient and may not even be required [15]. Upon presentation to the emergency department, the patient should receive a thorough evaluation incorporating a history, a physical exam, and laboratory and radiographic testing [16]. Fortunately, the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Emergency Medical Treatment and Active Labor Act (EMTALA) require appropriate screening for all patients seeking treatment in the emergency department [14].…”

Altered mental status in COVID-19

“…The root basis of AMS is an impairment of consciousness, which may be caused by a wide spectrum of conditions that induce acute brain dysfunction [3]. There are two interrelated domains of neurologic function that govern conscious behavior: the level of consciousness and the content of consciousness [3,4]. The level of consciousness refers to the state of arousal (or wakefulness) and responsiveness to the surrounding environment and stimuli [3,4].…”