![]() ![]() It is important to realize however that your assessment of a patient doesn't stop there, a patient can be both alert and oriented and still be altered. It is also easy to identify patients as altered if they don't know the answer to simple orientation questions related to who they are, where they are, and the date. It is easy to identify an altered patient if they have an altered level of consciousness. In addition for secondary assessment, you learned about assessing for orientation and how to further categorize decreased levels of consciousness in a trauma patient using the Glasgow Coma Scale or GCS. You learned in the first course that the primary assessment of the mental status includes a brief evaluation using AVPU which stands for alert, response to verbal stimuli, response to painful stimuli, or is unresponsive. Any injury or disease process that impacts the reticular activating system or cerebral hemispheres can impact a patient's mental status. The reticular activating system isn't a specific structure in the brain, but instead is a network of nerve cells that are a highway of information from the environment to the cerebrum and back. In the brain, our arousal and awareness is controlled by the reticular activating system in the cerebrum. Our mental status is a combination of two parts Our arousal, meaning our wakefulness or responsiveness and our awareness, referring to our perception of our environment. Your detective work is never more important than when you come upon a patient with altered mental status. As you will see, there are countless reasons why a person could be altered and a thorough and standardize approach to the altered patient is really important in order to not miss a reversible or serious cause. We have included the very broad topic of altered mental status in the neurology section because ultimately if someone is altered, it is because something is not functioning right in the brain. You get to use the stories people tell, the evidence you find on scene, and your physical assessment of the problem to help guide you to hypotheses on what is actually going on. In many ways, being an EMT is like being a detective. Thankfully, there are usually other clues to help us distinguish what the primary problem might be, and help narrow that differential diagnosis we keep talking about. ![]() Fast breathing could be from the heart, lungs, or from diabetic ketoacidosis like you learned about in the last video. If you've gone through the respiratory and cardiac modules, you might have noted that shortness of breath or trouble breathing can be a symptom of a heart problem or a lung problem. ![]() I'm sure you are starting to notice as you go through some of the lessons from the modules in this course, many of the symptoms of diseases we have talked about overlap. ![]()
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