From the Research
I strongly recommend using the following admission note dot phrase for Altered Mental Status (AMS): "Patient presents with altered mental status. Onset: [acute/gradual]. Associated symptoms: [fever/headache/focal neurologic deficits/etc]. Baseline mental status: [describe]. Recent medication changes: [list]. Substance use: [alcohol/drugs/etc]. Vital signs: [include abnormalities]. Physical exam: [level of consciousness, orientation, focal findings]. Initial workup: CBC, CMP, UA, UDS, blood cultures (if febrile), CT head, CXR. Consider LP if meningitis/encephalitis suspected. Initial management: IV access, oxygen if hypoxic, glucose check, thiamine 100mg IV if alcohol use suspected, naloxone 0.4-2mg IV if opioid overdose suspected. Differential diagnosis includes: metabolic (electrolyte abnormalities, hypoglycemia, uremia), infectious (UTI, pneumonia, meningitis), toxicologic (medication effect, substance intoxication/withdrawal), neurologic (stroke, seizure, ICH), and psychiatric causes. Plan: [specific interventions based on suspected etiology]."
This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of a comprehensive approach to evaluating and managing AMS 1. The study highlights the need for a systematic evaluation to identify the underlying cause of AMS, which can have numerous potential etiologies.
Key Elements of the Admission Note Dot Phrase
- Onset and associated symptoms
- Baseline mental status and recent medication changes
- Substance use and vital signs
- Physical exam and initial workup
- Differential diagnosis and plan
Importance of a Comprehensive Approach
The comprehensive approach outlined in the admission note dot phrase is necessary because AMS can have numerous potential etiologies, including metabolic, infectious, toxicologic, neurologic, and psychiatric causes 2, 3, 4. A systematic evaluation is required to identify the underlying cause and initiate appropriate treatment promptly.
Recent Studies Supporting the Recommendation
Recent studies have emphasized the importance of a comprehensive approach to evaluating and managing AMS. For example, a 2024 study published in Nature reviews. Disease primers highlights the need for a systematic evaluation to identify the underlying cause of AMS 2. Another study published in 2021 in High altitude medicine & biology emphasizes the importance of a comprehensive approach to managing AMS, including the use of acetazolamide and other medications 3.