Clinical Field Guide

AEIOU-TIPS: The Altered Mental Status Mnemonic, Letter by Letter

No labs. No CT. Just your eyes, your hands, a monitor and a glucometer. Here's how to work an altered patient, catch the thing that's trying to kill them, and pick the right hospital.

By L.J. Relle, BBA, NRP, FP-C, CCP-C • Published • Last reviewed • 14 min read
Quick answer

AEIOU-TIPS is a mnemonic for the causes of altered mental status: alcohol and acidosis, epilepsy and electrolytes, insulin, oxygen and overdose, uremia, trauma and temperature, infection, poisoning, and stroke or shock. On every altered patient, check pulse oximetry, then blood glucose, then the cardiac monitor before you work the letters and choose a destination.1

Illustration of a paramedic assessing a confused patient at home, with a monitor, glucometer and pulse oximeter.
Illustration by Pacific Biomedical.

What does AEIOU-TIPS stand for?

AEIOU-TIPS is a checklist of causes for an altered or unresponsive patient. In the order most clinical references use, insulin is the first I and infection is the second. S includes stroke, shock, subarachnoid hemorrhage, and sepsis.1319 Some sources swap the two I's, so you may see infection listed first.17 Either way, the list covers the same ground. Run the whole list on every altered patient.

Letter Stands for What it looks like Field move
A Alcohol, acidosis (and arrhythmia) Odor of alcohol, deep rapid breathing, abnormal rhythm Scene survey, monitor, think occult head injury
E Epilepsy, electrolytes, endocrine, encephalopathy Postictal state, subtle twitching, thyroid or adrenal history History, seizure precautions
I Insulin: too low or too high Diaphoresis, low or very high glucose, Kussmaul breathing Glucometer, oral glucose, D10, or glucagon per protocol
O Oxygen, overdose (opioids) Low SpO2, respiratory rate 12 or less with pinpoint pupils Oxygen to SpO2 of 94% or higher (88-92% in COPD). Naloxone if indicated
U Uremia and other organ failure Dialysis patient, missed session, liver disease Transport to a dialysis-capable emergency department
T Trauma, temperature Head injury, anticoagulants, hot or cold patient Head-to-toe exam, core temperature, cool or rewarm
I Infection, sepsis Fever, urinary tract infection, pneumonia, skin source Vitals trend, sepsis screen, prenotify
P Poisoning, psychiatric Carbon monoxide, chemicals. Psychiatric illness only after medical causes are out Air monitor, SpCO, rule out medical causes
S Stroke, shock, subarachnoid hemorrhage, sepsis (plus syncope, space-occupying lesion, shunt) Facial droop, arm drift, speech, gaze, poor perfusion BE-FAST, large-vessel screen, stroke center

Why use a mnemonic for altered mental status at all?

Altered mental status is a symptom, not a diagnosis, and it is common. In one university emergency department, about 5% of all patients presented altered. Their final diagnoses were neurologic 28%, toxicologic 21%, trauma 14%, psychiatric 14%, infectious 10%, and endocrine or metabolic 5%. Sixty-four percent were admitted and 9% died.2

That spread is why a checklist helps. When the pressure is on, your brain wants the easy story. He is just drunk. That is how you blow past the bleed hiding behind the alcohol on his breath. I have watched that happen. AEIOU-TIPS keeps the guessing structured, and naming the cause also tells you which hospital can finish the job.

What should you check first in an altered patient?

Before the alphabet, do the routine work well. Bring your bags to the patient, get a full set of vitals with a cuff that fits the arm, and dig for history. A recent discharge summary tells you in ten seconds what a shoebox of pill bottles takes five minutes to reveal. The evidence-based prehospital recommendations say to get the history of present illness, past history, and any prior episodes from the patient or caregiver, and to do a thorough physical exam on every altered patient.1

The same recommendations call for three checks on every altered patient.1 Run them in this order, then work AEIOU-TIPS and choose a destination.

  1. Pulse oximetry. Give oxygen to keep SpO2 at 94% or higher, or 88-92% with COPD. Avoid hyperoxia.1 Read the number on a pulse oximeter.
  2. Blood glucose. Treat per local protocol. An example threshold is under 60 mg/dL. The California EMS directors' committee, as cited in the prehospital recommendations, recommends treating adult hypoglycemia at 60 mg/dL, and possibly at higher levels in people with diabetes when clinically indicated.1 Check it on a glucometer. The American Diabetes Association classifies hypoglycemia as level 1 under 70 mg/dL, level 2 under 54 mg/dL, and level 3 as any glucose with altered mental or physical status that needs another person's help.4
  3. Cardiac monitor. Rhythm problems drop perfusion to the brain. Consider a 12-lead for possible ingestion, overdose, or an abnormal rhythm.1
Flowchart: check SpO2, check blood glucose, put the patient on a cardiac monitor, then work through AEIOU-TIPS and choose a destination.
What not to do

The old coma cocktail (empiric dextrose, naloxone, thiamine, and flumazenil for everyone) should not be used for undifferentiated altered mental status.1 Treat what you find.

Make the safety call early, too. If you cannot keep the patient safe, decide on soft restraint or, at the medic level, sedation before it turns into a wrestling match in the back of the truck.

How do you measure mental status in the field: AVPU or GCS?

Use one standardized scale and document it the same way every time. The evidence review recommends the Glasgow Coma Scale (GCS) or the FOUR score for level of consciousness, and AVPU (Alert, Voice, Pain, Unresponsive) for a rapid first look, because AVPU correlates well with GCS.1

GCS is heavily weighted toward the motor score, which can mislead in a patient who cannot cooperate.1 The single most useful question is what is normal for this person. Get the baseline from family or staff. An acute change from baseline is what you are chasing.

Alcohol, acidosis, arrhythmia

A: Alcohol, Acidosis (and Arrhythmia)

Alcohol

  • Check whether the scene backs up an alcohol story. Intoxication is a perfectly good reason to act goofy, and most of the time it is not an immediate life threat. It becomes one when they cannot protect their airway.
  • Intoxication makes your assessment less accurate, and intoxicated patients are at higher risk for occult traumatic brain injury, especially intracranial hemorrhage.1
  • A drunk patient with a real medical complaint may not have the capacity to refuse. Follow your local refusal policy.

Acidosis

You cannot run a blood gas in the truck, but you can see the tell: deep, rapid Kussmaul breathing. In diabetic ketoacidosis it often comes with a fruity, acetone smell on the breath.5

Arrhythmia

Arrhythmia is an addition many field providers use. When the rate is too fast, too slow, or irregular, cardiac output drops, so the brain is underperfused even when the oxygen and the glucose are fine. That is why a cardiac monitor goes on every altered patient.1 In patients 65 or older whose history suggests a heart problem, actively consider a cardiac cause of the altered mental status.1

Epilepsy, electrolytes, endocrine, encephalopathy

E: Epilepsy, Electrolytes, Endocrine, Encephalopathy

Epilepsy and seizure

A postictal patient is altered. Do not assume every quiet, confused patient is just postictal.

  • Nonconvulsive status epilepticus can look like subtle facial or limb twitching, automatisms, eye deviation, repetitive behaviors, or a prolonged postictal phase.
  • In one EEG study, undifferentiated altered patients had about a 5% chance of being in nonconvulsive status. The prehospital recommendations say to consider treating when those signs are present.1

Electrolytes

Sodium and calcium problems can scramble mentation. Hyponatremia, hypernatremia, hypocalcemia, and hypercalcemia all appear on standard coma and altered-mental-status differentials.17 Picture the patient who has been vomiting or sweating for two days.

Endocrine

Thyroid and adrenal disease belong here. Adrenal insufficiency, hypothyroidism, and hypopituitarism are recognized causes of coma.17 Diabetes has its own letter, under insulin.

Encephalopathy

Wernicke encephalopathy is an acute neuropsychiatric syndrome caused by thiamine (vitamin B1) deficiency. It is still greatly underdiagnosed, and the treatment is parenteral thiamine.15 Think of it in heavy drinkers and malnourished patients. That thiamine replacement belongs with encephalopathy. T is trauma and temperature. Hepatic encephalopathy and uremic encephalopathy come from organ failure.17

Insulin, glucose too low or too high

I: Insulin, blood sugar too low or too high

Low (hypoglycemia)

About 12% of hypoglycemic patients present with altered mental status.1

  • If they are awake enough to swallow and protect their airway, give oral glucose. The ADA names glucose as the preferred treatment for a conscious person under 70 mg/dL, and says to recheck about 15 minutes after treatment and repeat if the glucose is still low.4 When they are borderline but can still sip, I use a regular soda or juice through a straw. It is a lot harder to choke on than paste shoved in the cheek. Confirm the number on a glucometer before you call the sugar fixed.
  • If they cannot swallow, give IV dextrose. Many systems have moved from D50 to D10, with no increase in time to symptom resolution.1
  • Intramuscular glucagon works, and it is slower. Median time to full orientation was 10-30 minutes with glucagon, compared with 1-10 minutes for IV dextrose.1
  • Then ask why the sugar fell. A skipped meal and an infection underneath are both common. Have them eat before you accept a refusal.

Treat-and-release

Criteria vary by system. The NASEMSO model guideline, as summarized by NAEMSP, allows release without transport only when all of these are met:18

  • Repeat glucose is above 80 mg/dL.
  • The patient takes insulin or metformin.
  • The patient is back to normal mental status with no focal deficits.
  • The patient can eat and will eat.
  • The patient refuses, and EMS agrees that transport is not indicated.
  • A reliable adult will stay with them.
  • There are no complicating symptoms.
  • A clear cause has been identified.

Seizures or persistent symptoms mean transport.18 Follow your protocol.

High (DKA and HHS)

The 2024 hyperglycemic-crises consensus report replaced the 2009 statement.5

  • Diabetic ketoacidosis is now defined with a glucose of at least 200 mg/dL, or a known history of diabetes, plus ketosis and acidosis.5
  • About 10% of DKA is euglycemic (under 200 mg/dL), for example with SGLT2 (sodium-glucose cotransporter 2) inhibitors, pregnancy, reduced intake, or alcohol.5 A normal-looking glucose does not rule DKA out.
  • Hyperosmolar hyperglycemic state is more common in older adults with type 2 diabetes. Infection, such as a urinary tract infection or pneumonia, is a common precipitant, along with missed insulin.5
  • In both conditions, altered mental status is a marker of severity.5 These patients go to the hospital.

Oxygen, overdose

O: Oxygen and Overdose

Oxygen

You checked SpO2 at the start. Keep rechecking it. Titrate to the target, 94% or higher, or 88-92% in COPD, and do not chase 100%.1 A handheld monitor that reads saturation and end-tidal carbon dioxide belongs on that same pass, especially when the respiratory rate is low.

Overdose and opioids

  • Look for pill bottles and paraphernalia, then the pupils. Pinpoint pupils lean opioid. Dilated pupils lean stimulant or another sympathomimetic.
  • The criteria that best predict a naloxone response are a respiratory rate of 12 or less, pinpoint pupils, drug paraphernalia, and altered mental status. Pinpoint pupils were the best single sign, at 91% sensitivity.1
  • Intranasal naloxone is about as effective as IV or intramuscular naloxone, though it needs rescue doses more often.1 Evidence-based EMS guidelines support intranasal and IV dosing and titration.6
  • Do not give naloxone empirically without a clinical suspicion of opioids.1

Uremia

U: Uremia and other organ failure

Uremia is a kidney problem, not a bladder problem. When the kidneys quit, toxins build up, and uremic encephalopathy is a recognized cause of coma. So is hepatic encephalopathy.17 The one I see over and over is the dialysis patient who missed a session. The fix is dialysis, and by the time we get called that means a hospital that can do it, rather than their usual outpatient clinic.

Trauma, temperature

T: Trauma and Temperature

Trauma

  • Do a real head-to-toe exam. Look for goose eggs, raccoon eyes, and bruising. The view from the doorway misses those.
  • Consider traumatic brain injury in any undifferentiated altered patient, especially with intoxication, anticoagulant or antiplatelet therapy, or older age.1
  • A patient on blood thinners who fell and is now altered has a bleed until imaging says otherwise.

Temperature: cold

Hypothermia is staged by core temperature and level of consciousness.13 A core temperature below 32 °C is moderate hypothermia, not profound hypothermia. Severe hypothermia begins below 28 °C.

Stage Core temp Typical findings
Hypothermia I (mild) 35-32 °C (95-89.6 °F) Conscious, shivering
Hypothermia II (moderate) Below 32 °C down to 28 °C (below 89.6 °F down to 82.4 °F) Impaired consciousness. The patient may or may not shiver.
Hypothermia III (severe) Below 28 °C (below 82.4 °F) Unconscious, with vital signs present
Hypothermia IV (severe) Variable Apparent death

Patients at risk of imminent cardiac arrest should go to a center that can do extracorporeal life support (ECLS).13 That risk group includes a core temperature below 30 °C in young, healthy patients, or below 32 °C in older adults or people with comorbidities, plus ventricular dysrhythmias, or a systolic blood pressure below 90 mmHg.

Stop further heat loss with a reflective blanket, and run IV fluids or blood through a fluid warmer before they hit the vein.

Temperature: hot

Heatstroke is a rise in core temperature above 40 °C (104 °F) with central nervous system dysfunction. The only specific therapy is rapid cooling.14 If grandma is 104 °F and not making sense, you may have found the cause. Fever from infection is the other common hot cause.

Infection, sepsis

I: Infection and Sepsis

Infection, and the sepsis it drives, will make somebody altered, especially an older patient. A good exam usually finds the source.

  • Skin or wounds. Look for a sore that has gone bad.
  • Urinary tract. Burning, cloudy, or foul urine plus brand-new confusion is a combination you will see constantly in older women.
  • Respiratory. Listen for a wet cough and junky lung sounds.

Screening

  • Altered mentation is one of the three qSOFA criteria, along with a respiratory rate of at least 22 per minute and a systolic blood pressure of 100 mmHg or less. Two or more suggest a higher risk of poor outcomes in suspected infection.7
  • The 2021 Surviving Sepsis Campaign guideline says not to use qSOFA alone as a screening tool, compared with SIRS, NEWS, or MEWS.8
  • Use your service's sepsis screen, and prenotify the receiving hospital.

Poisoning, psychiatric

P: Poisoning and Psychiatric

Poisoning

  • Carbon monoxide is the sneaky one: gas appliances, a bad furnace, a house fire. A standard pulse oximeter overestimates true oxygen saturation in carbon monoxide poisoning. In one study the SpO2 stayed high while measured oxyhemoglobin fell, and the gap roughly equaled the carboxyhemoglobin level.12
  • Bring a four-gas meter in with you. When smoke or carbon monoxide is in the picture, use a CO-oximeter that reads SpCO so you are not guessing from a standard pulse oximeter.
  • Fire smoke can also carry cyanide, and mixed household chemicals are another classic exposure.
  • Monitoring the air keeps you from becoming the second patient.

Psychiatric

Psychiatric disease is real. Psychiatric diagnoses made up 14% of emergency department altered patients in one study.2 It is a diagnosis of exclusion. Clear the medical causes first.

Stroke, shock, subarachnoid hemorrhage, sepsis

S: Stroke, Shock, Subarachnoid Hemorrhage, Sepsis

Stroke

  • Run a stroke screen. The Cincinnati Prehospital Stroke Scale checks facial droop, arm drift, and speech.10
  • FAST alone missed 14% of ischemic strokes in one stroke center's records. Adding balance (gait or leg weakness) and eyes (visual symptoms), which makes the screen BE-FAST, cut the missed proportion to 4.4%.9
Icons for the BE-FAST stroke signs: balance, eyes, face, arm, speech and time.
Illustration by Pacific Biomedical.
  • Then look for large-vessel occlusion clues. The RACE scale scores facial palsy, arm and leg weakness, gaze deviation, and aphasia or agnosia, to predict a large arterial occlusion.11
  • The destination is a stroke center. A freestanding emergency department cannot do much more for a stroke than you can.

Subarachnoid hemorrhage and meningitis

Coma with meningism, a stiff neck, points to subarachnoid hemorrhage or meningoencephalitis.17

Shock

Poor perfusion means a poorly perfused brain. Treat the cause and the pressure. Shock, including septic shock, is one of the common causes of altered mental status in children.1

Sepsis

Sepsis screening belongs with the infection workup. Many versions of the mnemonic also list sepsis under S.319

Field additions under S

  • Syncope. The patient passed out and came back. Chase the cause.
  • Space-occupying lesion. A tumor, abscess, or subdural hematoma can cause coma with focal signs.17
  • Shunt. A failing ventriculoperitoneal shunt lets intracranial pressure climb. You can often feel the reservoir and the tubing running down the neck. The tubing feels like firm plastic instead of a vein.

How is altered mental status different in children?

The adult recommendations mostly apply to children, with a few differences.1

  • Common pediatric causes are seizures, shock (for example sepsis), brief resolved unexplained events (BRUE), hypoglycemia, and electrolyte problems.
  • Children are also at higher risk of hypoglycemia from ethanol ingestion, dehydration, and sepsis.
  • Traumatic brain injury, including non-accidental trauma, is a cause to keep in mind.
  • Stroke does happen in children, and recognition is often delayed.
  • Common toxic ingestions that cause altered mental status needing resuscitation include ethanol, clonidine, and acetaminophen.
  • Cardiac causes are rare, so a 12-lead is unlikely to help unless a dysrhythmia is suspected.

When a child cannot hold still for a glucose check or an exam, protective stabilization is a separate decision, with consent and monitoring.

Older adults: is it delirium, dementia, or something new?

Delirium is an acute disorder of attention and cognition in older adults. It is common, serious, under-recognized, and often fatal. Diagnosing it takes a cognitive assessment plus a history of acute onset.16 Dementia is the slow baseline. Delirium is the sudden change from that baseline. The question to ask is what they were like yesterday.

Older adults also carry extra risk on several letters:

  • occult brain injury after falls, especially on blood thinners1
  • hyperosmolar hyperglycemic state5
  • infection as a cause of new confusion
  • a lower temperature threshold for the risk of hypothermic cardiac arrest13

Where should an altered patient go? The destination rule

For a handful of these causes, the right hospital is the treatment.

  • A suspected stroke, especially with large-vessel occlusion signs, needs a stroke center.11
  • A STEMI needs a cath lab.
  • Uremia needs dialysis.
  • Hypothermia with a risk of cardiac arrest needs extracorporeal life support.13

The closest emergency department is better than no transport. Call medical direction when the hospital that can treat the cause is farther away.

Printable AEIOU-TIPS pocket card

Download the free AEIOU-TIPS pocket card. It is a one-page, two-sided card with the letter table, the three checks in order (pulse oximetry, then blood glucose, then the cardiac monitor), BE-FAST, and the hypothermia and heatstroke thresholds, with the references attached.

Frequently asked questions about AEIOU-TIPS

What does AEIOU-TIPS stand for in EMS?

Alcohol and acidosis, epilepsy, electrolytes, endocrine disease, and encephalopathy, insulin (glucose too low or too high), oxygen and overdose, uremia, trauma and temperature, infection, poisoning and psychiatric causes, and stroke, shock, subarachnoid hemorrhage, and sepsis. It is a checklist of possible causes of altered mental status. 1, 3

In the AEIOU-TIPS mnemonic, what does the "I" stand for?

There are two I's. In most clinical references, the first I is insulin (glucose too low or too high) and the second I is infection, including sepsis. Some sources reverse that order. 1, 3, 19, 17

In AEIOU-TIPS, what does "U" stand for?

Uremia means toxins building up when the kidneys fail. Think of the dialysis patient who missed a session. Some versions also count other metabolic or organ-failure causes here. 17

What is the AEIOU-TIPS mnemonic used for?

Use it to work through the differential diagnosis of an altered or unresponsive patient so the easy answer does not hide a dangerous one. EMS, emergency departments, and nursing all use it. It is a memory aid. It is not a diagnosis, and it is not a protocol. 1

What should you check first in an altered patient?

Check pulse oximetry, then blood glucose, then the cardiac monitor. Give oxygen to keep SpO2 at 94% or higher, or 88-92% with COPD, and avoid hyperoxia. Treat low glucose per local protocol. Consider a 12-lead for possible ingestion, overdose, or an abnormal rhythm. Evidence-based prehospital recommendations call for all three checks on every altered patient. 1

What blood sugar is too low?

The ADA defines level 1 hypoglycemia as under 70 mg/dL and level 2 as under 54 mg/dL. Many EMS systems treat altered adults under 60 mg/dL, and possibly at a higher number in people with diabetes. Follow your local protocol. 4, 1

What's the difference between AVPU and GCS?

AVPU (Alert, Voice, Pain, Unresponsive) is a fast four-level check. GCS scores eye, verbal, and motor responses. AVPU correlates well with GCS, and you should use one standardized scale the same way every time. 1

Can BLS providers treat altered mental status?

Yes, within scope. BLS care includes oxygen for hypoxia, oral glucose for a hypoglycemic patient who can swallow and protect the airway, scene and air safety, and transport to the right destination. Higher levels add IV dextrose, naloxone by the routes in protocol, an advanced airway, and monitoring.

Is altered mental status always an emergency?

Treat it as an emergency until proven otherwise. In one emergency department study, 64% of altered patients were admitted and 9% died. 2

Carry the right tools into every call

Carry a pulse oximeter, a CO-oximeter that reads SpCO, a glucometer, a monitor, a cuff that fits, a reflective blanket, and fluid warmers on the altered-patient call.

How American crews learned to do this work is the history of EMS in America.

L.J. Relle, BBA, NRP, FP-C, CCP-C Clinical Manager, Pacific Biomedical

L.J. is a career firefighter and paramedic who has served the greater New Orleans area for more than 20 years, working across high-volume fire, EMS, flight, and critical care agencies, and a veteran of Hurricane Katrina and other major disaster responses. A passionate advocate for fire-based EMS, he trains the next generation of providers and advises medical device manufacturers on EMS-optimized equipment, including as Clinical Manager for Pacific Biomedical.

References
  1. Sanello A, Gausche-Hill M, Mulkerin W, et al. Altered mental status: current evidence-based recommendations for prehospital care. West J Emerg Med. 2018;19(3):527-541. doi:10.5811/westjem.2018.1.36559
  2. Kanich W, Brady WJ, Huff JS, et al. Altered mental status: evaluation and etiology in the ED. Am J Emerg Med. 2002;20(7):613-617. doi:10.1053/ajem.2002.35464
  3. Weiglein T, Zimmermann M, Niesen WD, et al. Acute onset of impaired consciousness. Dtsch Arztebl Int. 2024;121(15):508-518. doi:10.3238/arztebl.m2024.0079
  4. American Diabetes Association Professional Practice Committee. 6. Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S132-S149. doi:10.2337/dc26-S006
  5. Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycemic crises in adults with diabetes: a consensus report. Diabetes Care. 2024;47(8):1257-1275. doi:10.2337/dci24-0032
  6. Williams K, Lang ES, Panchal AR, et al. Evidence-based guidelines for EMS administration of naloxone. Prehosp Emerg Care. 2019;23(6):749-763. doi:10.1080/10903127.2019.1597955
  7. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287
  8. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y
  9. Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke. 2017;48(2):479-481. doi:10.1161/STROKEAHA.116.015169
  10. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med. 1999;33(4):373-378. doi:10.1016/S0196-0644(99)70299-4
  11. Pérez de la Ossa N, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the Rapid Arterial Occlusion Evaluation scale. Stroke. 2014;45(1):87-91. doi:10.1161/STROKEAHA.113.003071
  12. Bozeman WP, Myers RA, Barish RA. Confirmation of the pulse oximetry gap in carbon monoxide poisoning. Ann Emerg Med. 1997;30(5):608-611. doi:10.1016/S0196-0644(97)70077-5
  13. Paal P, Pasquier M, Darocha T, et al. Accidental hypothermia: 2021 update. Int J Environ Res Public Health. 2022;19(1):501. doi:10.3390/ijerph19010501
  14. Bouchama A, Abuyassin B, Lehe C, et al. Classic and exertional heatstroke. Nat Rev Dis Primers. 2022;8(1):8. doi:10.1038/s41572-021-00334-6
  15. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442-455. doi:10.1016/S1474-4422(07)70104-7
  16. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. doi:10.1016/S0140-6736(13)60688-1
  17. Nickson C. Coma DDx. Life in the Fast Lane. Updated July 7, 2024. https://litfl.com/coma/
  18. Arbona Calderón DI. Can you leave them be? A review of the recommendations of hypoglycemia treat and release protocols. NAEMSP. June 30, 2018. https://naemsp.org/2018-6-30-can-you-leave-them-be-a-review-of-the-recommendations-of-hypoglycemia-treat-and-release-protocols/
  19. Society for Academic Emergency Medicine (CDEM). Approach to altered mental status (M4 curriculum). https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-approach-to/approach-to-altered-mental-status

This article is intended for educational purposes for trained EMS professionals and does not replace local protocols, medical direction, or formal clinical training. Always practice within your scope and your service's current clinical guidelines.