AEIOU TIPS is a mnemonic device taught to first responders to deal with Altered Mental State (AMS) patients. 

Although a first responder’s job doesn’t include rooting out the cause of unconsciousness, being aware of underlying issues can aid in providing life-saving first aid. 

As a first responder in medical emergencies, you should typically undertake ABC:

• keep Airways open
• keep the patient Breathing
• perform CPR

However, you may need to implement the AEIOU TIPS assessment when the patient showcases symptoms of AMS. 

First responders can derive information about the patient’s condition by implementing this assessment. Also, medical professionals can use this information to quickly narrow down the appropriate line of treatment for the patient.

What Does AEIOU TIPS Stand for?

This mnemonic device is a checklist for identifying the reason for the Altered Mental State (AMS).

A – Alcohol (overconsumption or withdrawal)

E – Epilepsy (seizure)

I – Insulin (overdose in diabetic patients)

O – Overdose (drugs)

U – Uraemia (renal failure)

T – Trauma

I – Infection (sepsis)

P – Psychiatric condition

S – Stroke/Shock

First responders are in a convenient position to determine these AMS-causing factors. They’re the first to notice the initial behavioral changes in the patient and can assess the nearby area for any signs of substance use.

Hence, first responders with knowledge of the AEIOU TIPS protocol provide better assistance while dealing with AMS patients.

Alcohol

Patients with a history of alcohol abuse can collapse from the effects of long-term drinking. Heavy drinkers develop certain health complications and become sensitive to specific medications. For instance, habitual drinkers need more anesthesia as compared to non-drinkers.

Hence, first responders should derive information about alcohol use from family members to relay it to medical professionals.

Alcohol withdrawal can also be a causal factor for AMS. Alcoholics with a problem of binge drinking can face uncomfortable withdrawal symptoms like:

• Nausea
• Sweating
• Insomnia
• Agitation
• Mood swings
• Depression 

While these symptoms are not life-threatening, some graver symptoms may arise on quitting alcohol cold turkey. 

One such symptom is Delirium Tremens (DT).

Sudden interruption to the drinking habit affects the balance of brain chemicals and attacks the functioning of the central nervous system. In that scenario, a patient suffers from DT.

Patients with DT can collapse from the disorientation of the brain. They can fall and become unconscious from any resulting head injury.

In other cases, DT has health complications that induce AMS. Investigating the incidents or symptoms leading to the patient’s unconscious state can reveal an underlying fatal condition.

Stroke, cardiac arrest, and seizure are the most lethal outcomes of alcohol withdrawal. In each of these conditions, the patients pass out without prior warning.

First responders to such scenes may perform the AEIOU TIPS investigation with the patient’s family to identify the factor causing AMS. It can clarify the following:

• Whether the patient was a heavy drinker or not, this information will influence the use of any medication and its amount in the patient’s line of treatment. 
• Whether the patient has an alcohol abuse disorder or not, this information will help identify any fatal health complication requiring immediate medical attention.

Epilepsy

Epileptic patients are prone to sudden seizures. Although epileptic seizures are generally not life-threatening, it’s pertinent to use AEIOU TIPS assessment to ascertain whether the patient has epilepsy to rule out other health issues. 

Note: Epilepsy usually results in grand mal seizures.

A grand mal seizure occurs when an abnormally synchronized electrical activity passes through the brain. Its physical outcomes include violent muscle contractions coupled with a loss of consciousness. 

Some patients with a history of grand mal seizures pass out after an epileptic attack. The duration of unconscious state persists for a few minutes after the convulsion ceases. If this time frame elongates, there can be other issues at play.

A person suffering from low blood sugar, stroke, or lethal infection can showcase similar symptoms. 

First responders can perform the AEIOU TIPS analysis to ascertain the presence of epilepsy. After ruling it out, they can check for other causal factors to reach a coherent treatment recommendation. 

If the patient with AMS has a history of epileptic seizures, the line of treatment is to follow accordingly. In other cases, further physical assessments and tests ensue to check for the occurrence of insulin overdose.

Insulin Overdose

After striking epilepsy off the checklist, first responders may check for symptoms of insulin overdose. 

Diabetic patients can experience AMS after accidentally overdosing on insulin. The increased insulin in the body raises glucose absorption in cells while reducing glucose production in the liver. This results in low sugar levels. 

As a first responder, you can affirm the likelihood of insulin overdose by observing the following signs in the patient:

• Extreme hunger
• Irritability
• Anxiety 
• Confusion
• Sweaty/ clammy skin
• Trembling hands
• Fatigue

In severe cases of insulin overdose, the person may experience seizure or loss of consciousness. 

First aiders—who arrive after the person passes out— should perform the AEIOU TIPS analysis by asking people surrounding the patient if they noticed the signs mentioned above.

Drug Overdose

If first responders find an unconscious person in an environment containing needles or drug pouches, their automatic response should be to check for an overdose. 

In the absence of any direct evidence indicating drug overdose, you may implement AEIOU TIPS analysis by asking bystanders if they observed the following symptoms in the patient:

• Nausea 
• Difficulty in walking
• Agitation or acts of violence 
• Tremors
• Convulsions
• Hallucination

If they fail to derive such information, they should check whether the patient has dilated pupils. 

Drug overdose has lethal implications, such as death. If the first responders conclude OD to be the cause of the patient’s AMS, immediate treatment recommendations might speed up the recovery process. 

Healthcare providers may opt for the following line of treatment on receiving the intimation about a possible OD:

• Insert a breathing tube if the reaction from the overdose inflamed the airways. 
• Introduce activated charcoal in the patient’s body to absorb the toxins. 
• Stomach pumping to remove the drug from the body.
• Inducing vomiting to remove the toxins from the stomach
• Removing drugs quickly through intravenous fluids. 

If the first responder’s suggestions mention drugs like heroin, the medical professional will treat the patient with available antidotes, like Naloxone. 

Substance overdose usually results in loss of consciousness and can lead to death. Therefore, first responders should apply AEIOU TIPS analysis to check for overdose if they find the AMS patient under suspicious circumstances. 

Uremia

Patients with acute or chronic renal failure develop symptoms of uremia. It’s a condition caused by hindered kidney function whereby urea, and other nitrogenous toxins, build up in the body.

The early symptoms of uremia are listed below:

• Nausea 
• Vomiting
• Anorexia 
• Weight Loss
• Muscle Cramps
• Fatigue
• AMS

If uremia remains undetected, it might translate into a coma. Thus, it’s pertinent to acknowledge its early symptoms and proceed with dialysis to reverse them. 

Typically, the first responders in cases of uremia are family members and close friends. They are aware of the patient’s physical condition and medical history. 

On noticing the onset of the signs mentioned above, first responders should approach medical professionals with a treatment recommendation of urgent dialysis. 

This prognosis may dampen the intensity of early signs and prevent them from reaching the stage of stupor or coma.

Trauma

As per research, trauma ranks second in the list of causes of emergency AMS. 

Trauma, in this context, refers to Traumatic Brain Injury (TBI). This condition occurs when a person experiences a severe blow to the head. In cases of TBI, internal damage is yielded by the brain hitting the skull.

Head trauma usually arises in incidents of car accidents. First responders to the site of the accident should watch out for the following signs of TBI:

• Confusion
• Convulsions
• Slurred speech 
• Unusual behavior
• Dilated pupils
• Sensitivity to light 
• Nausea 

Many patients suffer from a different set of symptoms that don’t appear at the first instance, like:

• Fatigue
• Mood changes
• Restlessness 
• Agitation
• Headaches

There can be two scenarios where first responders use AEIOU TIPS to ascertain the possibility of trauma.

Right after the accident 

First aiders may look for slurred speech, dilated pupils, loss of consciousness, or seizures to see if the patient has suffered a TBI. 

Severe head trauma may result in signs like nausea, vomiting, headache, blurred speech, confusion, or seizure. These are the indications of a brain bleed. 

In this situation, the patient should be rushed to the nearest emergency center and given the treatment recommendation of surgery. 

Few hours or days after the accident

Some patients appear to be fine at the accident site. However, the symptoms of TBI slowly arise after a while and reflect on their cognitive abilities. 

Memory loss, confusion, difficulty walking, double vision, trouble waking up, and slurred speech are signs that point to the possibility of a TBI. 

The family members, being the first responders in such scenarios, should look out for these symptoms in the person who experienced the car crash. 

If the symptoms become more apparent and intense, seek professional medical consultation. 

Infections

The leading cause of AMS after trauma is infection. 

A person contracts an infection when microorganisms enter their body and interfere with the functioning of the organs. In response to interference, the human body spikes the count of white blood cells to fight against infectious invasions.

However, if the spread of infection doesn’t cease, the human body may opt for an extreme response and cause sepsis. This life-threatening condition begins a chain reaction leading to multiple organ failure. 

Early signs of sepsis are: 

• Fever
• Difficulty breathing
• Low blood pressure
• Fast heart rate
• Mental confusion

Early detection of sepsis allows healthcare workers to mitigate the damage while keeping organ failure at bay. 

First responders can look for these symptoms in a person suffering from AMS. If you root out infection as the probable source of health problems by using AEIOU TIPS assessment, it may eliminate the need for running unnecessary laboratory tests.

Psychiatric Disorder

At times, the factor inducing AMS is a mental disorder. 

AMS is prominent in patients with psychiatric conditions like dementia and psychosis. 

First responders in the instance of dementia are family members who can notice its early symptoms like memory loss. Although irreversible, its symptoms are manageable with early detection and medication.

Similar to dementia, the symptoms of psychosis (like hallucination, agitation, or delusion) become evident to close friends and relatives first. However, its early detection with AEIOU TIPS analysis may ensure effective recovery without the chances of its reoccurrence.

Stroke

Although confusion or loss of consciousness falls in non-traditional symptoms of stroke, it’s still a symptom that first responders shouldn’t overlook. 

However, AMS symptoms become more noteworthy after the stroke passes. The effects of strokes impact the patient’s mind and alter their behavior. 

In this scenario, the AEIOU TIPS may indicate the changes in the patient’s behavioral pattern. The first respondent can give the treatment recommendation of counseling therapy based on such assessment. 

Medical professionals may take up the suggestion and recommend the patient to a qualified therapist. 

This assessment can also extend to the family members of the patients. As stroke affects the emotional well-being of the loved ones— the patient’s family may develop signs of AMS and require medical attention.

The Bottom Line

There are several variations of this mnemonic device.

Some versions cater to untrained first responders to improve their treatment recommendations to medical professionals. Other versions aid healthcare workers posted at the medical emergency department.  

The AEIOU TIPS assessment enhances the quality of preliminary diagnosis in the medical field and removes the hit-and-trial method of conducting random laboratory tests.

Treatment recommendations of first responders often influence the line of treatment in cases of a medical emergency. Hence, first responders and first aiders should be aware of the nuances of the AEIOU TIPS.

While this assessment technique focuses on AMS-related medical issues, other mnemonic devices exist for different ailments.

If you know about such mnemonic devices or first-response tricks, share them with us in the comments!