When should a 32-year-old woman with severe menstrual pain, tachycardia (heart rate 90), mild hypertension (bp 140/80), normoxia (o2 100%), mild hyperglycemia (bgl 111), altered mental status, and responsiveness to pain be treated as an Advanced Life Support (ALS) patient versus a Basic Life Support (BLS) patient?

From the Guidelines

The 32-year-old woman described should be treated as an Advanced Life Support (ALS) patient due to her altered mental status and responsiveness only to pain. While her vital signs show only mild abnormalities (tachycardia, mild hypertension, and mild hyperglycemia), the altered level of consciousness is the critical factor requiring ALS intervention. ALS providers can perform a more thorough neurological assessment, administer medications if needed, and provide advanced airway management if her condition deteriorates. The combination of severe menstrual pain with altered mental status could indicate various serious conditions including but not limited to severe hemorrhage, ectopic pregnancy, sepsis, or other gynecological emergencies. ALS providers have the training and equipment to administer IV fluids, pain medication, and other interventions that may be necessary. They can also perform more advanced monitoring during transport. While her oxygen saturation is normal, the altered mental status suggests potential for deterioration, and ALS providers are better equipped to respond to sudden changes in patient condition. This case demonstrates that the decision between ALS and BLS is not solely based on vital sign abnormalities but must consider the overall clinical presentation, with neurological status being a particularly important factor 1.

Some key points to consider in this case include:

• The patient's altered mental status and responsiveness only to pain indicate a need for advanced neurological assessment and potential intervention 1.
• The combination of severe menstrual pain with altered mental status could indicate a serious underlying condition requiring prompt medical attention 1.
• ALS providers are trained to perform advanced airway management, administer medications, and provide other interventions that may be necessary in this case 1.
• The patient's normal oxygen saturation does not rule out the potential for deterioration, and ALS providers are better equipped to respond to sudden changes in patient condition 1.
• The decision between ALS and BLS should be based on the overall clinical presentation, including neurological status, rather than solely on vital sign abnormalities 1.

From the Research

Patient Assessment

• The patient is a 32-year-old woman with severe menstrual pain, tachycardia (heart rate 90), mild hypertension (bp 140/80), normoxia (o2 100%), mild hyperglycemia (bgl 111), altered mental status, and responsiveness to pain.
• The patient's altered mental status is a significant concern, as it can be a symptom of a underlying condition that requires immediate attention 2, 3.
• The patient's vital signs, including heart rate, blood pressure, and oxygen saturation, are within normal limits, but the altered mental status and responsiveness to pain only, suggest a potential need for advanced life support.

ALS vs BLS Patient

• A patient with altered mental status, such as this one, should be treated as an Advanced Life Support (ALS) patient if they require interventions such as cardiac monitoring, intravenous access, or administration of medications to manage their condition 4.
• However, if the patient's condition can be managed with basic life support measures, such as oxygen therapy, bleeding control, or splinting, they can be treated as a Basic Life Support (BLS) patient.
• In this case, the patient's altered mental status and severe menstrual pain suggest a potential need for ALS interventions, such as administration of pain medication or further diagnostic testing to determine the underlying cause of their condition.

Treatment and Management

• The patient's severe menstrual pain can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium, which has been shown to be effective in relieving menstrual pain 5.
• However, the patient's altered mental status and responsiveness to pain only, suggest a potential need for further diagnostic testing and management to determine the underlying cause of their condition.
• The patient's treatment and management plan should be tailored to their specific needs and should include a comprehensive assessment and evaluation to determine the underlying cause of their condition 2, 3.