3- AMS & Toxicology Flashcards
Alert (level of consciousness) is defined as awake/ fully aware of surroundings, and responds appropriately to normal stimuli but does NOT imply what?
Capacity to focus attention
What level of consiousness if defined not fully alert/ drifts to sleep when not stimulated, limited awareness, and loses train of thought constantly/ consistently?
Lethargic/ somnolent
What level of consciousness is defined as difficult to arouse, and when aroused is confused, and constant stimulation is required to elicit minimal cooperation?
Obtunded
What level of consciousness is defined as not rousing spontaneously, requires persistent/ vigorous stimulation for very little response, and when aroused will moan or mumble?
Stuporous/ semicomatose
What level of consciousness is defined as “unarousable unresponsiveness”?
Coma
(severity graded by GCS 3-15)
Is decerebrate or decorticate posturing worse?
Decerebrate
What GCS score sustained for > 72 hours indicates a very poor prognosis?
≤ 8
(also intubate b/c unable to protect airway)
What is the DSM-5 criteria for major neurocognitive disorder (dimentia)? (5)
- Sig cognitive decline in ≥ one of: learning/ memory, language, exec fxn, complex attn, perceptual motor fxn, social cognition
- Impairment acquired/ sig decline from previous functioning
- Interference w/ independence
- Do not occur exclusively in context of delerium
- Not better explained by another disorder
How is delirium defined?
Disturbance of consciousness/ altered cognition that develops over a relatively short period of time, NOT characterized by focal/ lateralized neurologic findings
Delirium may require weeks or months to fully resolve. How does it affect morbidity/ mortality?
Both HIGH
Mortality x2 if medical condition + delirium
What is the greatest RF for delirium?
Underlying brain disease
(ex. dimentia, stroke, Parkinson’s)
What are the usual etiologies of AMS?
MOVE STUPID
Metabolic (hypo/ hypernatremia, hypercalcemia)
Oxygen (hypoxia)
Vascular (CVA, bleed, MI, CHF)
Endocrine (hypoglycemia, thyroid)
Seizure (postictal state)
Trauma, temperature, toxins
Uremia
Psychogenic
Infection
Drugs (intoxication/ withdrawal)
What is included in eval of AMS aside from ABC’s, pulse ox/ cardiac monitoring, and hx/ PE?
Assess vitals, mental status (GCS), pupil size, temperature
Start interventions
What labs should be ordered for a pt with AMS?
CMP, CBC, UA, pregnancy test
While trying to ID the underlying cause of AMS, what 3 meds might you consider giving to the pt? (little to no harn using even if you’re wrong)
Thiamine, dextrose, naloxone
What intervention should be reserved for tx of severe agitation or psychosis with the potential for harm to patient, providers, or family?
Low-dose haloperidol
When should benzodiazepines be avoided/ considered in the tx of AMS?
Avoided in undifferentiated AMS
Considered in withdrawl from sedative drugs/ alcohol OR anticholinergic poisoning
What drug class is not effective in preventing/ treating sxs of delirium and often create undesirable SEs?
Cholinesterase inhibitors
Physiologic excitement/ CNS stimulation will show elevations in HR, BP, RR, and temperature. What med classes have the potential to cause this?
Anticholinergics
Sympathomimetics
Central hallucinogen agents
Drug withdrawal (EtOH)
Physiologic depression/ depressed mental status will show reductions in HR, BP, RR, and temperature. What med classes have the potential to cause this?
EtOH/ methanol/ ethylene glycol
Sedative-hypnotics
Opiates
Cholinergics
Sympatholytics
Pt with polydrug OD, exposure to metablic poisons or heavy metals will display what effects?
Mixed physiologic
What procedures are used to enhance elimination of poisons?
Forced diuresis
Urine ion trapping
Hemodialysis
Exchange transfusion
What are the MOAs for antidotes?
Prevent absorption
Bind/ neutralize poisons directly
Antagonize end-organ effects
Inhibit conversion to more toxic metabolites
When might toxicity recur after giving an antidote?
Antidote eliminated more rapidly than ingested substance (ex. Naloxone)
May require repeated admin/ continuous infusion
