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Emergency Medicine Final > Altered Mental Status > Flashcards

Altered Mental Status Flashcards

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1
Q

What relates to the patient’s awareness and responsiveness to his or her surroundings?

A

level of consciousness

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2
Q

What is a term for profound depression of level of consciousness?

A

stupor

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3
Q

What term is used for unconsciousness?

A

coma

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4
Q

What is an acute confusional state with organic etiology. There is altercation in both the level of consciousness and content of thought. Reversible.

A

Delirium

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5
Q

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.

A

Dementia

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6
Q

What is the loss of ability to distinguish reality from fantasy.

A

Acute psychosis

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7
Q

If altered level of consciousness is present what 5 conditions should you consider (and R/O quickly?

A

Hypoxia or hypoglycemia
Sepsis
HTN encephalopathy
Wernicke’s encephalopathy

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8
Q

What other vital sign does Dettmann consider important?

A

SMELL

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9
Q

What acute neuro d/o’s need to be R/O’d?

A

Meningitis
SAH
CNS trauma/subdural hematoma
Seizures

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10
Q

What are the most frequent d/o’s causing altered behavior

A

Common systemic d/o’s:
UTI
PNA

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11
Q

What are other common causes of altered mental status?

A 
Drug interactions (common in elderly)
ETOH/illicit substance abuse/intoxication or withdrawal
Medication withdrawal or intoxication
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12
Q

What will be seen with Sympathomimetic toxidrome?

What are common meds?

A

all vital signs increased, hyperalert, agitation, hallucination, paranoia, mydriasis, hyperactive bowel sounds, sweating
Sudafed & coke

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13
Q

What will be seen with Anticholinergic toxidrome?

What are common meds?

A

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

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14
Q

What will be seen with Hallucinogenic toxidrome?

What are common meds?

A

all vital signs increased, hallucinations, perceptual distortions, agitation
mydriasis, nystagmus
MDMA, designer amphetamines

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15
Q

What will be seen with Opioid toxidrome?

What are common meds?

A

all vital signs SLOWED, CNS depression, coma, miosis (pinpoint pupil), hyporeflexia
Morphine, methadone, oxy

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16
Q

What will be seen with Sedative-hypnotics?

What are common meds?

A

all vital signs SLOWED, CNS depression, confusion, stupor, coma, hyporeflexia, nystagmus, miosis
benzo, ETOH, barbiturate

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17
Q

What will be seen with Cholinergic toxidrome?

What are common meds?

A

bradycardia, confusion, coma, miosis, SLUDGE

Organophosphates, insecticides

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18
Q

What will be seen with Serotonin Syndrome?

What are common meds?

A

all vital signs increased, Confusion, agitation, coma, mydriasis, hyperreflexia, sweating, flushing, trismus
MAOIs, SSRIs, TCAs

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19
Q

If patient has disorientation and memory difficulty? What are you thinking?

A

Medical or neurologic etiology

20
Q

If patient has disorders of thought content? What are you thinking?

A

Psychiatric etiology

21
Q

What do auditory hallucinations suggest?

A

Psychiatric etiology

22
Q

What do visual hallucinations suggest?

A

Medical etiology

23
Q

If the problem concerns level of consciousness what are you thinking?

A

likely medical

24
Q

What are things to keep in mind about psychiatric illness that present with altered mental status?

A

Schizophrenia & bipolar d/o frequently have recurring s/s and new onset is MC in younger adults

25
Q

What must the history include?

A

medications - current, recent, & hx of substance abuse

26
Q

If the eyes are fixed in one direction what are 2 possibilities?

A

Looking to the side of a hemorrhage or away from a mass lesion

27
Q

What are the 6 elements of mental status testing?

A 
Appearance, affect & attitude
D/o's of thought (delusions or hallucinations)
D/o's of perception
mood & affect
insight & judgment
sensorium & intelligence
28
Q

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?

A

Mental status testing

29
Q

If a patient is awake, alert, with unremarkable vitals signs, and without focal neurological deficit what is warranted?

A

Assessment of mental status including attention span

30
Q

What are 2 key findings in confusional states?

A

Presence of attention deficit & short-term memory

31
Q

What are the 3 components of the Glasgow Coma Scale (GCS) being evaluated?

A

Eyes open, best motor response, best verbal response

32
Q

What is the lowest score a patient can get on the GCS?

A

3 (1 = No response in each of the 3 categories)

33
Q

What is the maximum score a patient can get on the GCS?

A

15

34
Q

What is a “Nanagram”?

A

Anyone over 70 yo presenting with AMS requires a full workup in some institutions

35
Q

What test should you ALWAYS get on anyone presenting with confusion?

A

UA

36
Q

What are 2 quick tests that can be performed bedside?

A

Glucose & oxygenation

37
Q

What are some other things to consider in the work up?

A

EKG, lytes, CBC, ETOH, renal func
tox screen in young patients
CT for ICH or mass lesions

38
Q

What is the role of the emergency department?

A

Identify life-threatening conditions & stabilize patients

39
Q

What does emergency treatment always begin with?

A

ABCs

40
Q

What is the main goal of treatment?

A

Stabilization & symptom relief

41
Q

When should oxygen be giving?

A

patients with <92%, CO, stress

caution in COPD pts, may retain CO2 under high flow O2

42
Q

What should be given to all hyperventilating patients with AMS

A

Naloxone

43
Q

What is Section 12?

A

Emergency restraint & hospitalization of persons posing serious harm by reasons of mental illness

44
Q

When should Section 12 be used?

A

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.

45
Q

What is Section 35?

A

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

46
Q

What is critical to determine early in setting got altered mental status?

A

delirium vs dementia vs psychiatric

Emergency Medicine Final (2 decks)

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