24- altered mental status Flashcards
differential for altered mental status
Alcohol, ingested toxins Epilepsy, encephalitis, endocrine, electrolytes Infection (meningitis/sepsis) Overdose, opiates, oxygen deprived Uremia (renal failure) Trauma, temperature Insulin Psychosis Stroke, shock, space occupying lesions
Initial stabilization in a patient with Tachycardia, Hypotension, Hypoxia, and Hypoglycemia
A bolus of 20 cc/kg normal saline to treat tachycardia and hypotension
Administration of oxygen
A bolus of 10% or 25% solution of dextrose (D10 or D25).
organophosphates poisoning - cholinergic
DUMBBELLS diarrhea urination mitosis bradycardia bronchospasm Emesis lacrimation salivation/sweating
anticholinergic effects
Mydriasis (dilated pupils) "blind as a bat" Dry skin "dry as a bone" Red skin (flushed) "red as a beet" Fever "hot as Hades" Delirium and seizures "mad as a hatter" Tachycardia Urinary retention Ileus
opioids effects
Miosis (constricted pupils) Respiratory depression Bradycardia and hypotension Hypothermia Depressed mental status (sedation, confusion, coma)
what drugs cause mydriasis
G. Antidepressant H. Sedative-hypnotic I. Antihistamine J. Decongestant Submit
TCA effects
Altered mental status Anticholinergic signs and symptoms Hypotension (a hallmark of TCA toxicity) Dysrhythmias, and Seizures
serum alkalization indicated when…
QRS > 100 msec R wave in AVR > 3mm Wide-complex tachycardias Fluid-refractory hypotension Seizures
manage TCA toxicity
cardiac monitoring
serum alkalization and sodium loading
hypertonic sodium bicarb
lidocaine
for seizures- bentos, barbitautes, or propofol
peak hours after nortryptiline OD
7-8 hrs
peak hours after glipizide toxicity
2-3 hours after ingestion, but can last 24 hours.
cause severe hypoglycemia if under 2
evaluate toxic ingestion- labs
Glucose electrolytes blood gas EKG Calcium toxicology screen acetaminophen
