After three long hours motoring up the Intracoastal Waterway, it’s time to wake your mate for his turn on the helm. He doesn’t answer your shouts from the companionway. Now what? You swing out of the channel and drop the hook in a small slough.

             Below, you find him asleep in the pilot berth. Maybe he didn’t hear you, or maybe he’s just real tired. But in spite your vigorous attempts to arouse him,  Fred makes only a half-hearted attempt to open his eyes and nothing intelligible in the way of a verbal response. He may not always be the brightest bulb in the tree, but this is definitely abnormal! Something is wrong with Fred’s brain.

             The brain is exquisitely sensitive to oxygen deprivation, metabolic derangement, and toxins. Changes in brain function are often the first clue to an evolving systemic problem. Mental status changes are early symptoms. A person may be awake but irritable, confused, and complacent as is seen in early mild hypothermia. Or, a person may exhibit reduced inhibitions and ebullient behavior, as often develops on the third or fourth rum punch.

             As more serious problems develop, the level of consciousness changes. We describe this as being V, P,or U on the AVPU scale: A = Awake, V = responsive to verbal stimuli, P = responsive to painful stimuli, and U = completely unresponsive. Your mate is V on the AVPU scale and you have no idea what could be wrong with him.

             Since this yacht delivery is not a hospital ship, you don’t have much in the way of lab tests and instruments to evaluate your mate-turned-patient. You do, however, remember some of your training. Yes…there was a clever pneumonic to help sort out what might be wrong when somebody’s brain is not working the way it should. “STOPEATS” covers the generic problems associated with changes in brain function. You wonder if…

             S = Sugar. Low blood sugar in diabetics can cause mental status changes and loss of consciousness. But, you’ve known this guy for years and he’s not a diabetic. Besides, he just ate lunch two hours ago.

             T = Temperature. Hypothermia and Heat Stroke both result in mental status changes and loss of consciousness when severe. A quick exam determines that he’s neither hot nor cold. This can’t be a temperature problem.

             O = Oxygen. There’s nothing to indicate he’s been asphyxiated or drown. His skin color is very pink, not blue as you might expect with asphyxia. This is probably not an oxygen problem.

             P = Pressure. This refers to elevated intracranial pressure from brain swelling that can develop after a concussion or stroke. But, there’s been no trauma and he’s too young to be much of a risk for stroke. You eliminate pressure as a factor.

             E = Electricity. Nope. No lightning storms today. There’s no AC genset on this boat. There is no possibility of an electrical injury.

             A = Altitude. His berth is actually at the waterline. Can’t get any closer to sea level than that. Another possibility crossed off.

             T = Toxins. How about toxins? Could he have taken something or been poisoned? A quick look around the salon reveals no pill bottles or Jim Beam empties. He’s not the kind of guy that would do that, anyway. But, can’t rule it out yet. Toxins remain possible.

             E = Electrolytes. This refers to body salts that can become too diluted when a person drinks way too much water and doesn’t eat enough food. Also called exertional hyponatremia. Not Fred, he certainly eats enough and is not prone to exertion.

             That leaves toxins. All other possibilities have been eliminated. What about the air? It does smell in here. Suddenly it becomes obvious. You’ve been motoring for three hours with a slight breeze astern. The exhaust has been blowing right down the companionway. Carbon monoxide! That explains Fred’s nice pink skin and the headache you’ve developed since you came below. You haul his limp form into the fresh air on deck and call for help. Another life saved by a simple pneumonic.

"To Those in the Field"

S.T.O.P.E.A.T.S.

© 2004 Jeffrey E. Isaac, PA-C