AEIOU-TIPS pocket card
AEIOU-TIPS pocket card
Altered mental status. A checklist, not a diagnosis. Follow your protocol.
Every altered patient, in this order
- SpO2. Oxygen to at least 94%, or 88 to 92% with COPD. Do not chase 100%.
- Glucose. Treat per protocol. Many systems treat altered adults under 60 mg/dL. ADA level 1 is under 70 mg/dL, level 2 under 54 mg/dL.
- Cardiac monitor. Consider a 12-lead for a possible ingestion, overdose, or an abnormal rhythm.
Then work the letters and pick the hospital that can treat the cause. Do not give a coma cocktail to undifferentiated altered patients.
| Letter | Stands for | Field move |
|---|---|---|
| A | Alcohol, acidosis, arrhythmia | Scene survey. Watch for occult head injury. |
| E | Epilepsy, electrolytes, endocrine, encephalopathy | Seizure precautions. Think Wernicke in malnourished drinkers. |
| I | Insulin: glucose too low or too high | Oral glucose if they can swallow. Otherwise D10 or glucagon per protocol. |
| O | Oxygen, opioid overdose | Naloxone when RR is 12 or less, pupils are pinpoint, and the story fits. Not empiric. |
| U | Uremia | Missed dialysis goes to a hospital that can dialyze. |
| T | Trauma, temperature | Head-to-toe. Core temp. Cool or rewarm. |
| I | Infection | Source exam. Sepsis screen. Prenotify. |
| P | Poisoning, psychiatric | CO and scene air. Psych is a diagnosis of exclusion. |
| S | Stroke, shock, SAH, sepsis | BE-FAST and an LVO screen. Stroke center when it fits. |
BE-FAST
Balance, Eyes, Face, Arm, Speech, Time. FAST alone missed about 14% of ischemic strokes in one center. Adding balance and eyes cut that to about 4.4%.
Temperature
- Hypothermia II, moderate: core under 32 C (89.6 F), impaired consciousness. Under 90 F is not profound.
- Hypothermia III, severe: under 28 C (82.4 F), unconscious, vital signs present.
- Heatstroke: core above 40 C (104 F) with central nervous system dysfunction. Rapid cooling is the treatment.
Sources: Sanello 2018, West J Emerg Med, doi 10.5811/westjem.2018.1.36559. ADA Standards of Care 2026, section 6. Umpierrez 2024, Diabetes Care. Paal 2022, accidental hypothermia. Aroor 2017, Stroke. Full guide: shop.pacificbiomedical.com/blogs/clinical-resources/aeiou-tips-altered-mental-status-ems
Educational only. It does not replace local protocols, medical direction, or formal training. Pacific Biomedical.