3.5. VIOLATION OF MENTAL STATE

Related Names

Confusion, altered level of consciousness.

Purpose of assistance

1. Identify problems that can be cured.
2. Protect the patient from injury.

Patient description

Inclusion criteria

Impaired decision-making ability.

Exclusion criteria

Traumatic brain injury.

Patient Management

Condition assessment

Look for causes of impaired consciousness that can be cured.

1. Respiratory tract – make sure of patency; if necessary, change the position of the patient’s body.
2. Breathing – inspect for deterioration of breathing; check the level of SPO2, EtSO2, CO.
3. Circulation – inspect for signs of shock.
4. Apply GCS and/or AVPU scale.
5. Pupils.
6. Neck stiffness or pain with certain movements.
7. Tool for assessing the presence of stroke.
8. Glucose index.
9. ECG – deterioration of perfusion due to arrhythmia.
10. Smell when exhaling air – unusual odors are possible, such as alcohol, sour smell or smell of acetone from the mouth.
11. Chest/abdomen – implantable assistive devices, abdominal pain or muscle tension.
12. Extremities/skin – marks, hydration level, swelling, dialysis shunts, temperature to touch (use a thermometer if possible).
13. The scene – inspect the place for the presence of pills, assess the temperature of the environment, the overall picture of the scene..

Treatment and intervention

1. Oxygen therapy (see General Rules of Assistance).
2. Blood glucose index (see instructions “Hypoglycemia” or “Hyperglycemia”).
3. Naloxone (see instruction “Poisoning/overdose with opioid drugs”).
4. Patient immobilization – physical and chemical (see instruction “Excited or aggressive patient/emergency related to behavior”).
5. Antiarrhythmic drugs (see guidelines section “Cardiovascular problems”).
6. Active cooling or warming (see. instruction “Hypothermia/exposure to a cold environment” or “Hyperthermia/exposure to a warm environment”).
7. IV fluids (see instructions “Shock,” “Hypoglycemia” and “Hyperglycemia” regarding the doses of medicines).
8. Vasopressors (see instruction “Shock”).

Patient safety

1. With a depressed mental state, the main focus is on airway control, oxygenation, ventilation and perfusion.
2. Aggressive patients may need pharmacological and/or physical control to allow for examination and treatment.
3. Patients with hypoglycemia and hypoxia may be irritable or aggressive (see instruction “Excited or aggressive patient/emergency related to behavior”).

Useful information for training

Key points

1. Information about the events from passers-by at the scene.

2. Age of the patient.

3. The environment in which the patient was found.

4. Recent complaints (eg – headache, chest pain, difficulty breathing, nausea, fever).

5. Product/drug packages:

a) anticoagulants;
b) antidepressants;
c) narcotic painkillers;
d) benzodiazepines.

6. Medical bracelets and auxiliary medical devices.

7. Assess the presence of reduced oral capacity and/or vomiting and/or diarrhea or dehydration, which is the cause of altered state of consciousness in elderly patients and children.

8. Medications that children may have access to include (but are not limited to):

a) antihypertensive;
b) tablets for hyperglycemia;
c) opioids;
d) benzodiazepines;
f) anti-epileptic.

Relevant evaluation results

1. Special marks.
2. The smell of exhaled air.
3. Skin temperature.
4. Location.
5.  
6. Assessment on the scale of GCS and AVPU.
7. Body temperature is measured as much as possible.
8. Ensuring the safety of the patient and EMF employee.
9. Inspection of pupils and neck.

Criteria for the effectiveness of care
The presence of suspicion of hypoglycemia and its proper treatment.

Blood glucose measurement.