Altered Mental Status Flashcards
What relates to the patient’s awareness and responsiveness to his or her surroundings?
level of consciousness
What is a term for profound depression of level of consciousness?
stupor
What term is used for unconsciousness?
coma
What is an acute confusional state with organic etiology. There is altercation in both the level of consciousness and content of thought. Reversible.
Delirium
What is a slow deterioration of higher cortical function. These patients have a normal level of consciousness but thought content is affected. Cognitive function loss only. Not reversible.
Dementia
What is the loss of ability to distinguish reality from fantasy.
Acute psychosis
If altered level of consciousness is present what 5 conditions should you consider (and R/O quickly?
Hypoxia or hypoglycemia
Sepsis
HTN encephalopathy
Wernicke’s encephalopathy
What other vital sign does Dettmann consider important?
SMELL
What acute neuro d/o’s need to be R/O’d?
Meningitis
SAH
CNS trauma/subdural hematoma
Seizures
What are the most frequent d/o’s causing altered behavior
Common systemic d/o’s:
UTI
PNA
What are other common causes of altered mental status?
Drug interactions (common in elderly) ETOH/illicit substance abuse/intoxication or withdrawal Medication withdrawal or intoxication
What will be seen with Sympathomimetic toxidrome?
What are common meds?
all vital signs increased, hyperalert, agitation, hallucination, paranoia, mydriasis, hyperactive bowel sounds, sweating
Sudafed & coke
What will be seen with Anticholinergic toxidrome?
What are common meds?
all vital signs increased, hypervigilant, agitation, hallucination, coma, mumbling, blind as a bat, mad as a hatter, red as a beet, hot as hades, dry as a bone, bladder & bowel lose their tone
antihistamines, TCAs, antiparkinsonians, scopolamine
What will be seen with Hallucinogenic toxidrome?
What are common meds?
all vital signs increased, hallucinations, perceptual distortions, agitation
mydriasis, nystagmus
MDMA, designer amphetamines
What will be seen with Opioid toxidrome?
What are common meds?
all vital signs SLOWED, CNS depression, coma, miosis (pinpoint pupil), hyporeflexia
Morphine, methadone, oxy
What will be seen with Sedative-hypnotics?
What are common meds?
all vital signs SLOWED, CNS depression, confusion, stupor, coma, hyporeflexia, nystagmus, miosis
benzo, ETOH, barbiturate
What will be seen with Cholinergic toxidrome?
What are common meds?
bradycardia, confusion, coma, miosis, SLUDGE
Organophosphates, insecticides
What will be seen with Serotonin Syndrome?
What are common meds?
all vital signs increased, Confusion, agitation, coma, mydriasis, hyperreflexia, sweating, flushing, trismus
MAOIs, SSRIs, TCAs
If patient has disorientation and memory difficulty? What are you thinking?
Medical or neurologic etiology
If patient has disorders of thought content? What are you thinking?
Psychiatric etiology
What do auditory hallucinations suggest?
Psychiatric etiology
What do visual hallucinations suggest?
Medical etiology
If the problem concerns level of consciousness what are you thinking?
likely medical
What are things to keep in mind about psychiatric illness that present with altered mental status?
Schizophrenia & bipolar d/o frequently have recurring s/s and new onset is MC in younger adults
What must the history include?
medications - current, recent, & hx of substance abuse
If the eyes are fixed in one direction what are 2 possibilities?
Looking to the side of a hemorrhage or away from a mass lesion
What are the 6 elements of mental status testing?
Appearance, affect & attitude D/o's of thought (delusions or hallucinations) D/o's of perception mood & affect insight & judgment sensorium & intelligence
What is an assessment of the emotional and intellectual state of the individual at the moment of the examination. Informal evaluation can lead to missing important findings?
Mental status testing
If a patient is awake, alert, with unremarkable vitals signs, and without focal neurological deficit what is warranted?
Assessment of mental status including attention span
What are 2 key findings in confusional states?
Presence of attention deficit & short-term memory
What are the 3 components of the Glasgow Coma Scale (GCS) being evaluated?
Eyes open, best motor response, best verbal response
What is the lowest score a patient can get on the GCS?
3 (1 = No response in each of the 3 categories)
What is the maximum score a patient can get on the GCS?
15
What is a “Nanagram”?
Anyone over 70 yo presenting with AMS requires a full workup in some institutions
What test should you ALWAYS get on anyone presenting with confusion?
UA
What are 2 quick tests that can be performed bedside?
Glucose & oxygenation
What are some other things to consider in the work up?
EKG, lytes, CBC, ETOH, renal func
tox screen in young patients
CT for ICH or mass lesions
What is the role of the emergency department?
Identify life-threatening conditions & stabilize patients
What does emergency treatment always begin with?
ABCs
What is the main goal of treatment?
Stabilization & symptom relief
When should oxygen be giving?
patients with <92%, CO, stress
caution in COPD pts, may retain CO2 under high flow O2
What should be given to all hyperventilating patients with AMS
Naloxone
What is Section 12?
Emergency restraint & hospitalization of persons posing serious harm by reasons of mental illness
When should Section 12 be used?
Apply if failure to hospitalize such person would create a likelihood of serious harm by reason of mental illness may restrain or authorize the restraint of such person and apply for the hospitalization of such person for a 3-day period at a public facility or at a private facility.
What is Section 35?
allows a judge to “involuntarily commit someone whose ETOH or drug use puts themselves or others at risk”
Patient put into an abuse program for 90 days
What is critical to determine early in setting got altered mental status?
delirium vs dementia vs psychiatric
