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ASSESSING MENTAL STATUS
Methods to Assess Mental Status During the Interview
A competent EMS professional will use the patient interview process to determine the mental status of the patient through direct observation and conversation.
The EMS professional should assess the conversation, as it takes place, for:
- orientation (time and place),
- speech (fluency, content, comprehension),
- thinking, comprehension, and executive functioning,
- attention and concentration,
- memory (remote, recent, and immediate),
- affect (visible indications of mood), mood, and thought content,
- autonomic responses,
- facial movements (appropriate vs inappropriate),
- reactive movements (over-reactive and under-reactive), and
- grooming movements (appropriate vs inappropriate and tics).
All of these topics should help assist an EMS professional in determining a patient’s mental status and deciding whether or not the patient is at a normal, safe level of his or her mental state.
Formal Methods of Assessment
There are many scales, tools, and menmonics that are used to remember the key elements of mental status. Some of these have been heavily reviewed in EMT/AEMT units such as AVPU and the Glasgow Coma Scale. A more open-ended assessment of mental status is orientation.
There are four key elements to "orientation" Self, Time, Place, and Situation.
The ability to answer the following four questions implies normal mental functioning:
- "What is your name"
- "What is the date"
- "Where are we right now"
- "What lead to an ambulance being called for you"
Exploration is another method to review the patient’s internal experiences, assessed through the patient’s mood, energy level, and content of thinking.