Altered Mental Status

Question 1

What are the three general classifications of altered mental status?

Answer 1

dementia
delirium
psychosis

Question 2

Describe the initial evaluation for anyone with altered mental status?

Answer 2

A: airway
B: breathing
C: circulation
D: neurologic disability
E: expose for rapid head to tow eval

Question 3

What should all altered patients get for management early on in the ED course?

Answer 3

assessment of ABCs
cardiac monitorin
supplemental O2 if hyperemic
besides glucose testing
IV access
Eval for signs of trauma
consider naloxone administration if narcotic OD suspected
thiamine if alcohol suspected

Question 4

Describe the AEIOU TIPS mnemonic for AMS.

Answer 4

Alcohol
Epilepsy/Electrlytes/Encephalopathy
Insuiln
Opiates/Oxygen
Uremia
Trauma/Temperature
Infection
Poisons/Psychogenic
Shock/Stroke/Subarachnoid hem/space occupying lesion

Question 5

Describe the timing (onset) of delirium, dementia and psychosis.

Answer 5

dlirium: rapid onset
dementia: slow onset
Psychosis: variable

Question 6

Describe the course of delirium, dementia and psychosis.

Answer 6

delirium: fluctuating
dementia: progressive
psychosis: variable

Question 7

Which one has an altered level of consciousness?

Answer 7

delirium (and sometimes psychosis)

dementia usually has normal level fo consciousness

Question 8

Which one has visual hallucinations and which one has auditory hallucinations?

Answer 8

delirium more likely with visual hallucinations, psychosis more likely with auditory hallucinations and dementia rarely with hallucinations (but usually visual when they do occur)

Question 9

Usually AMS patients will need to be admitted, but what are the cases when they can potentially discharge home?

Answer 9

Patients with a known seizure disorder who have had their meds loaded with safe follow-up assured

Hypoglycemia corrected with dextrose if there was a clear reason for the hypoglycemia

Narcotic overdose who get naloxone and are observed in the ED until sober