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3. E Med & Surgery > 3- AMS & Toxicology > Flashcards

3- AMS & Toxicology Flashcards

1
Q

Alert (level of consciousness) is defined as awake/ fully aware of surroundings, and responds appropriately to normal stimuli but does NOT imply what?

A

Capacity to focus attention

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2
Q

What level of consiousness if defined not fully alert/ drifts to sleep when not stimulated, limited awareness, and loses train of thought constantly/ consistently?

A

Lethargic/ somnolent

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3
Q

What level of consciousness is defined as difficult to arouse, and when aroused is confused, and constant stimulation is required to elicit minimal cooperation?

A

Obtunded

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4
Q

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?

A

Stuporous/ semicomatose

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5
Q

What level of consciousness is defined as “unarousable unresponsiveness”?

A

Coma

(severity graded by GCS 3-15)

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6
Q

Is decerebrate or decorticate posturing worse?

A

Decerebrate

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7
Q

What GCS score sustained for > 72 hours indicates a very poor prognosis?

A

≤ 8

(also intubate b/c unable to protect airway)

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8
Q

What is the DSM-5 criteria for major neurocognitive disorder (dimentia)? (5)

A
  1. Sig cognitive decline in ≥ one of: learning/ memory, language, exec fxn, complex attn, perceptual motor fxn, social cognition
  2. Impairment acquired/ sig decline from previous functioning
  3. Interference w/ independence
  4. Do not occur exclusively in context of delerium
  5. Not better explained by another disorder
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9
Q

How is delirium defined?

A

Disturbance of consciousness/ altered cognition that develops over a relatively short period of time, NOT characterized by focal/ lateralized neurologic findings

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10
Q

Delirium may require weeks or months to fully resolve. How does it affect morbidity/ mortality?

A

Both HIGH

Mortality x2 if medical condition + delirium

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11
Q

What is the greatest RF for delirium?

A

Underlying brain disease

(ex. dimentia, stroke, Parkinson’s)

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12
Q

What are the usual etiologies of AMS?

A

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)

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13
Q

What is included in eval of AMS aside from ABC’s, pulse ox/ cardiac monitoring, and hx/ PE?

A

Assess vitals, mental status (GCS), pupil size, temperature

Start interventions

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14
Q

What labs should be ordered for a pt with AMS?

A

CMP, CBC, UA, pregnancy test

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15
Q

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)

A

Thiamine, dextrose, naloxone

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16
Q

What intervention should be reserved for tx of severe agitation or psychosis with the potential for harm to patient, providers, or family?

A

Low-dose haloperidol

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17
Q

When should benzodiazepines be avoided/ considered in the tx of AMS?

A

Avoided in undifferentiated AMS

Considered in withdrawl from sedative drugs/ alcohol OR anticholinergic poisoning

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18
Q

What drug class is not effective in preventing/ treating sxs of delirium and often create undesirable SEs?

A

Cholinesterase inhibitors

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19
Q

Physiologic excitement/ CNS stimulation will show elevations in HR, BP, RR, and temperature. What med classes have the potential to cause this?

A

Anticholinergics

Sympathomimetics

Central hallucinogen agents

Drug withdrawal (EtOH)

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20
Q

Physiologic depression/ depressed mental status will show reductions in HR, BP, RR, and temperature. What med classes have the potential to cause this?

A

EtOH/ methanol/ ethylene glycol

Sedative-hypnotics

Opiates

Cholinergics

Sympatholytics

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21
Q

Pt with polydrug OD, exposure to metablic poisons or heavy metals will display what effects?

A

Mixed physiologic

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22
Q

What procedures are used to enhance elimination of poisons?

A

Forced diuresis

Urine ion trapping

Hemodialysis

Exchange transfusion

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23
Q

What are the MOAs for antidotes?

A

Prevent absorption

Bind/ neutralize poisons directly

Antagonize end-organ effects

Inhibit conversion to more toxic metabolites

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24
Q

When might toxicity recur after giving an antidote?

A

Antidote eliminated more rapidly than ingested substance (ex. Naloxone)

May require repeated admin/ continuous infusion

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25
Q

When should you be cautious in using flumazenil for benzodiazepine reversal?

A

Chronic benzo use, can precipitate seizures

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26
Q

What is the antidote for acetaminophen?

A

N-acetylcysteine

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27
Q

What is the antidote for amitriptyline?

A

Sodium bicarb

28
Q

What is the antidote for anticholinergics?

A

Physostigmine

29
Q

What is the antidote for beta-blockers?

A

Glucagon

30
Q

What is the antidote for benzodiazepines?

A

Flumazenil

31
Q

What is the antidote for CCBs?

A

Calcium

32
Q

What is the antidote for coumadin?

A

Vitamin K, FFP

33
Q

What is the antidote for cyanide?

A

Hydroxocobalamin/ nitrates (inhaled)

34
Q

What is the antidote for Digoxin?

A

Digoxin antibodies (Digibind)

35
Q

What is the antidote for Heparin?

A

Protamine

36
Q

What is the antidote for Hydrofluoric acid?

A

Calcium

37
Q

What is the antidote for iron?

A

Desferrioxamine

38
Q

What is the antidote for methanol/ ethylene glycol?

A

Ethanol

39
Q

What is the antidote for methemoglobin?

A

Methyline blue

40
Q

What is the antidote for opiates?

A

Nalaxone

41
Q

What is the antidote for organophosphates/ anticholinesterases (cholinergics)?

A

Atropine, 2-PAM

42
Q

What is the antidote for salicylates?

A

Urine alkalization, dialysis

43
Q

What is the antidote for sulfonylureas?

A

Octreotide

44
Q

What drugs are tested for with a urine drug screen (UDS)? (8)

A

Opioids, BZs, cocaine, THC, barbiturates, amphetamines, TCAs, buprenorphine

45
Q

What drugs are tested for with serum screening? (8)

A

Acetaminophen, salicylates, carboxyHb, digoxin, Li, metals, ethylene glycol, antiepileptics

46
Q

What primarily distinguishes toxidromes?

A

Changes in vital signs and end orgal manifestations

47
Q

What labs for should be ordered for ALL poisonings, toxidromes, and patients with AMS?

A

Serum pregnancy test (women of childbearing age)

Fingerstick glucose

Acetaminophen/ salicylate testing (fatal co-ingestions but effective tx strategies)

48
Q

What are the most common causes of a cholinergic toxidrome?

A

Organophosphate/ carbamate insecticides

Nerve agents (sarin)

Nicotine

49
Q

What are the sxs a/w cholingergic toxidrome?

A

SLUDGE + the killer B’s + MIOSIS

Salivation
Lacrimation

Urination

Defecation

GI pain

Emesis

Bradycardia, bronchorrhea, bronchospasms

50
Q

What is the management for a cholinergic toxidrome?

A

Aggressive decontamination

Atropine

2-PAM

51
Q

What are the sxs a/w anticholinergic toxidrome?

A

Dilated pupils, agitation/ hallucinations/ delerium, flushed skin, hyperthermia, dry skin

(blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone)

Urinary retention, decreased bowel sounds, tachycardia

(the bowel and bladder lose their tone, and the heart runs alone)

*underlined = differentiation from sympathomimetic*

52
Q

What are the most common causes of an anticholinergic toxidrome?

A

Antihistamines, plants (Jimson weed)

53
Q

How is anticholinergic poisoning diagnosed?

A

Clinically, serum drug levels NOT helpful

54
Q

What is the management for anticholinergic poisoning?

A

Benzos (agitation)

Activated charcoal (relatively recent, must have N AMS/ be able to protect airway)

Physostigmine

55
Q

What are the most common causes of sumpathomimetic poisoning? (6)

A

Cocaine, amphetamines, ephedrine/ pseudoepedrine, bath salts, theophylline, caffeine

56
Q

What are the sxs a/w sympathomimetic poisoning?

A

Diaphoresis/ moist mucus membranes, hyperactive bowel sounds, dilated pupils, seizures, hyperthermia, tachycardia/ dysrhythmia, HTN, , agitation/ hallucinations/ paranoia

Mimics “fight or flight”

57
Q

Withdrawal of what appears similar to sympathomimetic poisoning?

A

Alcohol

58
Q

What is the management for sympathomimetic poisoning?

A

Benzos + supportive care

59
Q

Aside from opioids, what is another common cause of opioid poisoning?

A

Diphenoxylate

60
Q

What are the sxs a/w opioid toxidrome?

A

Hypothermia, bradycardia, hypotension, bradypnea/ apnea, pulmonary edema, CNS depression/ coma, miosis

61
Q

What is the management for opioid toxidrome?

A

Naloxone + supportive care

62
Q

In chronic narcotic users that are breathing, how is Naloxone dosed for an opioid overdose?

A

Start w/ lower dose (0.4mg) to avoid precipitating withdrawal

63
Q

What are the most common causes of sedative-hypnotic toxidrome? (7)

A

Benzos, barbiturates, GHB, carisoprodol, alcohols, zolpidem, flunitrazepam (Roofies)

64
Q

What are the sxs a/w sedative-hypnotic toxidrome?

A

Hypothermia, vitals N, bradypnea/ apnea, CNS depression/ coma, hyporeflexia, variable pupils

65
Q

What is the management for sedative-hypnotic toxidrome?

A

Time + supportive care

(rarely Flumazenil- can induce seizures in chronic benzo uders)

3. E Med & Surgery (19 decks)

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