Altered mental status (AMS) and syncope are common, yet challenging, presentations that EMTs and paramedics encounter in the pre-hospital setting. Prompt recognition and management are crucial to improving patient outcomes. To aid in the assessment, the acronym AEIOU-TIPS is a valuable tool that can help providers systematically evaluate potential causes of AMS and syncope.

AEIOU-TIPS: A Systematic Approach

A – Alcohol/Acidosis
E – Epilepsy (Seizures)
I – Infection
O – Overdose
U – Uremia (Kidney failure)
T – Trauma
I – Insulin (Hypoglycemia/Hyperglycemia)
P – Psychosis/Poisoning
S – Stroke/Shock

Detailed Breakdown:

  1. Alcohol/Acidosis:
    • Alcohol: Intoxication or withdrawal can significantly alter mental status. Look for signs of alcohol consumption or withdrawal symptoms such as tremors, hallucinations, and agitation.
    • Acidosis: Metabolic acidosis, such as diabetic ketoacidosis (DKA), can cause AMS. Check for fruity breath, dehydration, and rapid breathing.
  2. Epilepsy (Seizures):
    • Postictal states following seizures can present as AMS. Look for a history of epilepsy, recent seizure activity, and signs such as tongue biting or incontinence.
  3. Infection:
    • Severe infections, particularly sepsis, can lead to AMS. Assess for fever, chills, hypotension, tachycardia, and potential sources of infection (e.g., urinary tract, respiratory system).
  4. Overdose:
    • Drug overdoses, whether intentional or accidental, can alter mental status. Investigate for signs of drug use, pinpoint pupils, respiratory depression, or evidence of pill bottles or drug paraphernalia.
  5. Uremia (Kidney Failure):
    • Advanced kidney failure can cause AMS due to the accumulation of toxins. Look for a history of kidney disease, edema, hypertension, and decreased urine output.
  6. Trauma:
    • Head injuries, even those without obvious external signs, can result in AMS. Assess for mechanisms of injury, scalp lacerations, battle signs, or raccoon eyes indicating potential intracranial bleeding.
  7. Insulin (Hypoglycemia/Hyperglycemia):
    • Blood sugar imbalances are a frequent cause of AMS. Hypoglycemia can cause confusion, seizures, and unconsciousness, while hyperglycemia may present with dehydration and altered sensorium. Always check blood glucose levels in AMS patients.
  8. Psychosis/Poisoning:
    • Acute psychiatric conditions or poisoning from chemicals can cause AMS. Evaluate for psychiatric history, potential exposure to toxins, or signs of ingestion of poisonous substances.
  9. Stroke/Shock:
    • Cerebrovascular accidents (strokes) or shock (hypovolemic, cardiogenic, or distributive) can present with AMS. Look for unilateral weakness, facial droop, slurred speech (in stroke), or signs of shock such as hypotension, tachycardia, and poor perfusion.

Practical Application in the Field

When encountering a patient with AMS or syncope, perform a thorough assessment incorporating the AEIOU-TIPS acronym. Start with a primary survey to address life-threatening issues, followed by a secondary survey to delve into potential causes. Use the acronym as a checklist to ensure all possible etiologies are considered.


AMS and syncope require a methodical approach to identify underlying causes quickly. The AEIOU-TIPS acronym serves as an essential guide for pre-hospital providers, ensuring comprehensive assessment and timely intervention. By familiarizing themselves with this tool, EMTs and paramedics can enhance patient care and outcomes in these challenging scenarios.

Remember, rapid identification and appropriate management can make a significant difference in patient recovery and prognosis. Stay vigilant and thorough in your assessments, and use AEIOU-TIPS as a reliable framework in your practice.