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emed > altered mental status and coma > Flashcards

altered mental status and coma Flashcards

1
Q

what is delirium

A

arousal system dysfunction w/the content of consiousness affected as well, transient disorder w/ the impairment of attention and cognition

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2
Q

what is dementia

A

failure of the content portions of consciousness w/ relatively preserved alerting functions, loss of mental capacity,

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3
Q

define coma

A

failure of both arousal and content functions, reduced alterness and responsiveness form which the patient can’t be aroused

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4
Q

where are neurons that are responsible for arousal function from?

A

reticular acitivating system

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5
Q

where are the structures that are responsible for content of consiousness?

A

cerebral cortex

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6
Q

what are the 4 general causes of delirium?

A

primary intracranial disease,
systemic disease secondarily affecting CNS,
exogenous toxins,
drug w/ drawal

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7
Q

pathophysiology of dementia

A

most cases of dementia is caused by Alzheimers followed by vascular dementia

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8
Q

what is diagnostic of delirium?

A

acute onset of attention deficits and cognitive abilities fluctuating in seeverity throught the day and worsening at night

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9
Q

what is diagnostic of delirium?

A

acute onset of attention deficits and cognitive abilities fluctuating in seeverity throught the day and worsening at night

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10
Q

what are the clinical features of dementia

A

impairment of memory, PARTICULARLY RECENT MEMORY, that’s gradual and progressive w/ REMOTE MEMORIES preserved. Motor and Speech are also preserved. Early stage is associated w/ naming problems and forgetting common items, then middle stage people have problems reading and issues in social situations and loss of direction, late stage people are disoriented, and have inabiltiy to self care or have personality changes.

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11
Q

what is the difference between depression and delirium?

A

depressed patients are oriented and are able to perform commands

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12
Q

what is the difference between depression and delirium?

A

depressed patients are oriented and are able to perform commands

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13
Q

what is the pharmaceutical treatment for delirium?

A

haloperidol: 5-10 mg w/ reduced dosing to 1-2 mg in elderly

Benzo: lorazipam .5-2 mg may be used in conjunction w/ haloperidol doses 1-2 mg

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14
Q

what is the follow up for delirum?

A

admit, and further treatment unless READILY REVERSIBLE CAUSE is discovered

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15
Q

what is the follow up for delirium?

A

admit, and further treatment unless READILY REVERSIBLE CAUSE is discovered

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16
Q

what is the follow up for delirium?

A

admit, and further treatment unless READILY REVERSIBLE CAUSE is discovered

17
Q

what are the signs of vascular dementia?

A

fluctuating, stepped course

18
Q

dementia associated w/ stroke has to occur within how long of a stroke?

A

3 months

19
Q

when should you consider normal pressure hydrocephalus as a cause of dementia?

A

urinary incontinence and gait disturbance early in the disease, large ventricles on CT

20
Q

Glasgow coma scale

A

motor V6
verbal 5
eyes 4

21
Q

what is the max and min score in intubated patients?

A

10 T, 2T

22
Q

what does GCS of 13-15 mean?

A

mild head injury

23
Q

what does GCS of 9-12 mean?

A

moderate head injury

24
Q

<= 8 GCS score

A

severe head injury, needs intubation

25
Q

can a unilateral hemispheric disease like a stroke cause a coma?

A

no it needs to be bilateral

26
Q

what is an uncal herniation syndrome?

A

medial temporal lobe shifts to compress the upper brainstem which results in progressive drowsiness. Ipsilateral pupil is sluggish then becomes dilated and non reactive, and ipsilateral hemiparesis may occur

27
Q

what is central herniation syndrome

A

progressive loss of consiousness, loss of brainstem reflexes, decorticate posturing, irregulat posturing

28
Q

cerebral blood flow occurs normally at what mean aterial pressures? what can affect MAP?

A

50-100 mmHg, ICP

29
Q

what is a sign of pseudocoma?

A

avoidance gaze, pupillary responses, extraocular mvmts, muscle tone, and reflexes are also intact on examination

30
Q

abrupt coma suggests what?

A

catastrophic stroke or seizure

31
Q

slow progressive coma suggests?

A

tumor or subdural hematoma

32
Q

what is the neuroimaging of choice for a coma?

A

CT

33
Q

what is nonconvulsive status epilepticus?

A

generalized seizures and remain unrespsonseve may be in continuing state of seizures, consider if they seize and down wake up after 30 min

34
Q

what is the treatment for hypoglycemic coma?

A

dextrose w/ thiamine if alcohol abuse or malnutrition

35
Q

what should you use in a suspected opiate overdose?

A

naloxone

emed (11 decks)

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