Altered Mental Status Flashcards
A Glasgow coma scale of 8 indicates what action?
Intubate the patient as they cannot protect their own airway
What does the acronym ABCDEF stand for in the emergency management of a patient with AMS?
Airway, breathing, circulation, disability, environment, fingerstick
What does the acronym AEIOU-TIPS stand for in considering differential diagnosis in a patient with AMS?
Alcohol, electrolytes, insulin, opiates/oxygen, uremia, trauma, infection, poison, shock/stroke/seizure
A 79y/o patient presents to the ER with sudden AMS from his home. He talks about seeing someone in the room that isn’t there, and his children tell you he’s a professor at a local college who has normal daytime functioning and has had spells like this in the evenings before. His vitals and PE are unremarkable. What is the likely dx?
Delirium: This usually has a sudden onset of combative or confused behavior in an otherwise normal functioning person; can happen in geriatric PT at night (sun downing)
A patient experiences >5 minutes of continuous seizures or >2 seizures in between which they don’t regain consciousness. What is the dx?
status epilepticus
A patient presents with sensation of movement when there is none, what is the likely dx?
vertigo
What are the two classifications of vertigo?
Peripheral caused by the 8th cranial nerve
Central involving the cerebellum or brainstem
What are the two classifications of strokes?
Ischemic: lack of blood
Hemorrhagic: brain bleed
There are two types of ischemic strokes. What are they and define them?
Embolic: when a clot comes from somewhere else in the body and gets to the brain;
Thrombotic: a clot that forms in the arterial supply of the brain
This type of ischemic stroke is painless, causes sudden neuro deficits, and comes on in an instant
Embolic
This type of ischemic stroke has gradual onset of sx due to fluctuating hyperperfusion and gradual artery occlusion?
thrombotic
What are the two types of hemorrhagic strokes and their definitions?
Intracerebral: bleeding into the brain parenchyma
Subarachnoid: bleeding into the subarachnoid spaces
What are the indications for administering thrombolytic therapy in ischemic stroke patients?
- give within 3 H of stroke sx
- Blood pressure must be at least 180
- There cannot be an active bleed
What are 3 contraindications to administering thrombolytic therapy to an ischemic stroke pt?
- head trauma in last 3 months
- platelet count <100,00
- active bleed (anywhere, inside or out)
- stroke in last 3 months
- Its been over 3H since onset of stroke sx
If a patient presents with a sudden headache, unilateral eye pain, and vision loss you should consider this emergent dx?
angle closure glaucoma
If a patient presents to the ED with a headache and fever you should suspect these three emergent causes?
CNS infections: meningitis, encephalitis, brain abscess
What three things concerning onset of a headache are considered high-risk?
Sudden onset
onset with trauma
onset after exertion
What accompanying sx make a headache a more emergent complaint?
AMS
Fever
Neuro deficits
Seizure
vision changes
What are three indications that a patient presenting to the ED with a headache requires imaging?
- Worse headache of life
- HIV with severe headache (infectious cause)
- Different than normal headache
- Neuro deficit
- Headache lasting >3 days
- Vomiting in the morning with regular headaches
- Serious recent or past trauma
Treatment for Idiopathic intercranial hypertension?
Acetazolamide
Treatment for temporal arteritis?
prednisone
Treatment for cluster headache?
oxygen, then sumatriptan in O2 doesn’t help
If you suspect a patients seizures are from a toxin, what is the treatment?
benzos or barbituates
What are the three categories in which AMS is organized into? How can you differentiate them by onset and progression of course?
Delirium: rapid onset, course fluctuates (okay now, not okay later)
dementia: slow onset and very progressive course (slow, overtime)
psychosis: variable onset and course; can be unpredictable especially if undiagnosed or off meds
A patient experiencing disturbing hallucinations, with normal vitals and who is alert and oriented to a normal level is likely experiencing what categorization of AMS?
psychosis
