Emergency Medicine

ALTERED CONSCIOUS LEVEL

84 General Medical Emergencies

MANAGEMENT

1 Avoid the temptation to simply sedate the confused patient, without looking

carefully for the underlying cause(s).

2 Admit all patients under the appropriate specialist team.

Recall (3 points)

6. Now what were the three objects I asked you
   to remember?

Apple 1

Table 1

Penny 1

Language (9 points)

7. What is this called? (Show wristwatch) 1
   What is this called? (Show pencil) 1


8. I’d like you to repeat a phrase after me: No ifs ands or buts 1


9. Read the words on the bottom of this
   page and do what it says

Closes eyes 1

10. (Read the full statement below before
    handing the respondent a piece of paper.
    Do not repeat or coach)
    I’m going to give you a piece of paper.
    What I want you to do is take the paper
    in you right hand, fold it in half and put
    the paper on your lap

Takes with

right hand

1

Folds in half 1

Puts on lap 1

11. Write a complete sentence on this piece of paper. The
    sentence should have a subject, verb and make sense.
    Spelling and grammatical errors are OK

1

12. Here is a drawing. Please copy the
    drawing on the same piece of paper
    (Hand the respondent a drawing of
    two intersecting pentagons)

Correct if two

five-sided

pentagons

intersect to

make a four-

sided figure

1

Total score (out of 30)

CLOSE YOUR EYES

A score of 20 or less indicates cognitive impairment.
Higher scores are expected in the well-educated, and lower scores in the elderly, the
uneducated, and the mentally impaired.
From Folstein MF, Folstein SE, McHugh PR (1975) Mini-Mental State. A practical
method for grading the cognitive state of patients for the clinician. J Psychiatr Res
12:189–98.

Table 2.7 contd