#stopeats

Character E is confused. She thinks she's talking to someone besides Character F and accidentally admits that she has a crush on F while F is treating her injury. Oops.

Or, F is trying to get E out of the enemy base and E keeps laughing when F shushes her, attracting the attention of the guards

Whether for comedy or tension, altered mental status can add a fun wrinkle to your plot. But, what causes altered mental status and how do you make sure E survives?

STOPEATS

The big kahuna of the altered mental status world is the acronym STOPEATS. If it makes your brain go a bit wonky, it's probably included in STOPEATS.

Sugar

If E is a diabetic and lost track of her sugar intake, she could suffer from altered mental status as a part of hyperglycemia. If F knows E has diabetes, he can hopefully guess at the cause of her confusion and help her take her medication, or get her to a hospital.

Temperature

When the body gets really cold or really hot, the brain can stop working right. In fact, altered mental status is a key sign of being hypothermic vs. just cold. Ditto with heat stroke. Hopefully, the environment makes if obvious to F what is causing E's weird behavior. He can treat her by bringing her out of the cold or heat.

Oxygen

Hypoxia occurs when the brain is starved of oxygen, such as at a high altitude. It is most common in mountain climbers and pilots, such as the one in this video who reports having "no control" of his aircraft but otherwise, is not concerned at all about the situation. Astronomers may also suffer from hypoxia on occasion.

XKCD 1463: Altitude

Hypoxic people behave as if drunk. They are often euphoric, may speak slowly, and will act confused. The key treatment for high-altitude hypoxia is reducing altitude ASAP. In the video, you can hear the air traffic controller trying to coax the pilot lower. He knows he doesn't need the pilot to land—as soon as he can breathe a little better, he'll remember how to fly be able to land himself.

Pressure

If a brain injury causes bleeding in the skull, that blood has nowhere to go and can build up pressure. This causes the brain to lose functioning and is called intracranial pressure (ICP). It's the worst type of traumatic brain injury (TBI) besides one that just kills E outright.

If E is suffering from ICP, she'll probably be confused and behaving erratically. She may have gaps in her memory as well. Most likely, she'll also report "the worst headache of my life"—literally. In training, we were told to look out for that exact phrase when diagnosing head taumas. In later stages of ICP, E may also vomit, a lot.

Treatment involves getting to surgery ASAP so a doctor can cut open her skull and relieve some of the pressure. For obvious reasons, that is not something we attempt in the field.

Electricity

I'll be honest: I think they just wanted the acronym to work when they made this one E. What they actually mean in most cases is seizures. The classic seizure is a grand mal seizure, which involves the muscles tensing, twitching, etc. But seizures come in all shapes and sizes. For some, a seizure might mean smelling something that isn't there, or hearing music, or a single twitching muscle. Because seizures are unauthorized electrical activity in the brain, they can cause disorientation and erratic behavior.

Often, coming out of a seizure can be quite disorienting too. If F is helping E through a seizure, he should first try to prevent her from harming herself. If she's banging her head against the wall, that means putting a hand or pillow there. If she's near a table, that means moving the table. (NO sitting on / restraining people with seizures and NO putting stuff in their mouth! No! Why? You want them to choke? No!). As she recovers, F can remain calm, help her understand what happened if she needs it, and get her further care if requested.

Altitude

As with temperature, both very high and very low altitudes can cause brain problems (if you are beginning to suspect the brain is just a picky organ, you'd be correct). Scuba divers who ascend too quickly can suffer from nitrogen narcosis, which can lead to euphoria, confusion, memory loss, difficulty concentration, etc. (all classic signs of altered mental status).

If E goes too high, say, on a mountain, she could suffer from High-Altitude Cerebral Edema (HACE—controversial opinion but high-altitude stuff has all the good acronyms and names, HACE being but one example). It occurs when the brain swells at a high altitude and leads to confusion, lethargy, and a headache.

Luckily, as with most high-altitude problems, it can be solved quickly by going lower. When in doubt, on a mountain, taking the patient to a lower altitude is probably a good idea.

Toxins

Alcohol, LSD, marijuana, morphine—drugs cause altered mental status, as can bites or stings from venemous animals.

There are as many ways to treat toxins as there are toxins, maybe more, so I leave you with a fun fact the majority of snake bites in the US are people who tried to pick up the snakes.

In the words of Mod N's WFR instructor: "Red near black? Who cares. It's a snake. Why are you messing with snakes?"

Salt

Salt concentrations across cell membranes is one way nutrients travel into and out of cells. If E's blood suddenly has way less salt (electrolytes) than normal, this causes all the nutrients to flow out of her cells and into her blood, starving her organs. Brains run on salt and not having enough salt makes... neurons fire different? Stop firing? Something scientific and complicated. For our purposes: not enough salt = brain go weird.

This is called hyponatremia and is my favorite of all the STOPEATS ailments. Hyponatremic people behave as if drunk. The treatment is to 1) stop chugging water, 2) stop competing in your high-endurance sport (and therefore stop sweating), and 3) drink / eat something salty.

Conclusion

Give your characters altered mental statuses. It will be fun. I promise.

The most easily treatable problems that make brain go weird are: hypoxia and high-altitude cerebral edema.