Neurologic Emergencies: Stroke, Seizure, and Altered Mental Status

1. Altered mental status: work the reversible causes first

An altered patient in front of you could be a stroke, a seizure, a diabetic, an overdose, or a dozen other things. So before you chase a diagnosis, you rule out what you can actually fix on scene.

Run these every time:

Glucose. Check it on every altered patient, every time. Hypoglycemia mimics a stroke exactly, and it's the one cause you can reverse in minutes.
Oxygenation and ventilation. Hypoxia and hypercapnia both produce confusion. A pulse ox and a look at the respiratory effort tell you fast.
Opioids. Respiratory depression with pinpoint pupils is the pattern.
Perfusion. Shock shows up as confusion before it shows up as low blood pressure. Don't wait for the number to drop before you think shock.
Temperature. Hypothermia and hyperthermia both alter mental status.

Once you've worked those five, the rest of the differential is bigger, and that's what AEIOU-TIPS is for: Alcohol, Epilepsy/Electrolytes, Insulin, Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke/Seizure. You're not running all nine letters on every call. You're using them so you don't forget a category.

So that's the frame for the rest of this lesson: two organ systems, stroke and seizure, sitting inside that bigger differential. Both of them get worked the same way — reversible causes first.