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emergency medicine > AMS > Flashcards

AMS Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

List the range of consciousness

A
  1. alert
  2. lethargic, somnolent
  3. obtunded
  4. stuporous, semicomatose
  5. comatose
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2
Q

not fully alert and drifts off to sleep when not stimulated, awareness limited, unable to pay close attention, loses train of thought constantly and consistently

A

Lethargic or Somnolent

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3
Q

difficult to arouse, and when aroused, is confused. Constant stimulation required to elicit minimal effort

A

obtunded

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4
Q

Does not arouse spontaneously, requires persistent and vigorous stimulation for very little response. When aroused, will moan or mumble.

A
  • Stuporous or Semicomatose
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5
Q

unarousable unresponsiveness

A

coma

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6
Q

glasgow coma scale grades coma severity according to what 3 categories? highest score in each category?

A
  • eye opening (4)
  • motor (6)
  • verbal responses (5)
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7
Q

List the GCS for eye opening

A
  • 4= spontaneous
  • 3 = to voice
  • 2 = to pain
  • 1 = none
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8
Q

List the GCS for motor response

A
  • 6 = obeys commands
  • 5 = localizes to pain
  • 4 = withdraws from pain
  • 3 = flexor posturing
  • 2 = extensor posturing
  • 1 = none
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9
Q

List the GCS for verbal response

A
  • 5 = oriented
  • 4 = confused
  • 3 = inappropriate words
  • 2 = incomprehensible sounds
  • 1 = none
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10
Q

What is Decorticate posturing? Where is the brain damage

A
  • Decorticate = flexion with adduction of arms and extension of legs => flexor response
  • reflexts destructive lesion in corticospinal tract from cortex to uppermidbrain
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11
Q

What is Decerebrate posturing? Where is the brain damage

A
  • extension, adduction, and internal rotation of arms and extension of legs => extensor posturing
  • associated with damage to corticospinal tract at level of brainstem (pons or upper medulla)
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12
Q

Which is worse, decorticate or decerebrate posturing

A

Decerebrate

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13
Q

customary to intubate patient with a GCS of

A
  • < or = 8
    • likely they are unable to protect their airway
    • very poor prognosis if < or = 8 longer than 72 hours
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14
Q

Define condition

  • significant cognitive impairment in AT LEAST one of the following: learning, memoryn language, executive function, complex attention, perceptual motor function, and social cognition
  • impairement is acquired and decline from previous functioning
A

dementia: major neurocognitive disorder

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15
Q

define condition

  1. disturbance in attention and awareness
  2. develops over a short period of time, and tends to fluctuate during course of day
  3. additional disturbance in cognition
  4. disturbance is caused by a medical condition, substance intoxication or withdrawal, or medication side effect
A

Delirium

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16
Q

are focal or lateralized neurologic findings characteristic of delirium?

A

NO

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17
Q

list the risk factors for delirium

A
  1. underlying brain disease
  2. age > 80
  3. infection
  4. taking multiple medications
  5. ETOH use
  6. Men
  7. fracture
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18
Q

differentiate between delirium and major neurocognitive disorder in terms of

  • onset
  • vital signs
  • level of consciousness
  • hallucination
A

delirium

  • onset: rapid
  • vital signs: often abnormal
  • level of consciousness: altered
  • hallucination: visual

dementia

  • onset: slow
  • vital signs: normal
  • level of consciousness: normal
  • hallucination: rare
19
Q

list the etiology of AMS

A

MOVE STUPID

  • Metabolic (hypo/hypernatremia, hypercalcemia)
  • Oxygen (hypoxia)
  • Vascular (CVA, bleed, MI, CHF)
  • Endocrine (hypoglycemia, thyroid)
  • Seizure
  • Trauma, temperature, toxins
  • Uremia
  • Psychogenic
  • Infection
  • Drugs
20
Q

what are interventions that should be done while you are getting your history and physical exam of a AMS patient

A
  • oxygen
  • finger stick glucose
  • EKG
  • IV, draw labs
21
Q

What are labs that should always be ordered when assessing a patient with AMS

A
  • electrolytes
  • creatinine
  • glucose
  • calcium
  • CBC
  • UA
  • pregnancy test
22
Q

List the toxins that cause physiological excitation (CNS stimulation, elevation of HR, BP, RR, and Temp)

A
  • anticholinergic
  • sympathomimetics
  • central hallucinogen agents
  • ETOH withdrawal
23
Q

List the toxins that cause physiological depression (CNS depression, reduction of HR, BP, RR, and Temp)

A
  • ETOH, methanol, ethylene glycol
  • sedative-hyponotics
  • opiates
  • cholinergics
  • sympatholytics
24
Q

list the procedures to enhance elimination of poisons

A
  • forced diuresis
  • urine ion trapping
  • hemodialysis
  • exchange transfusion
25
Q

antidote for beta blockers

A

glucagon

26
Q

antidote for Benzodiazepine

A

flumazenil

  • can precipitate sz in patients who use benzos chronically
27
Q

antidote for opiates? duration of action

A
  • Naloxone
  • 45 minutes
28
Q

what are toxidromes

A

signs/symptoms that occur consistently as a result of a particular toxin

29
Q

what labs should you get for all poisoings, toxidromes, and patients with AMS

A
  • pregnancy test
  • fingerstick glucose
  • acetaminophen
  • salicylate
30
Q

List the causes of cholinergic toxidrome

A
  • organophosphate
  • carbamate insecticides
  • nerve agents
  • nicotine
31
Q

what is the cholinergic toxidrome

A
  • SLUDGE & the Killer B’s
  • Salivation
  • Lacrimation
  • Urination
  • Defecation
  • GI pain
  • Emesis
  • Bradycardia, Bronchorrhea, Bronchospasms
  • **Miosis
32
Q

antidote for cholinergic toxidrome

A
  • ATROPINE to help dry up secretions
  • Pralidoxime (2-PAM)
33
Q

what is the anticholinergic toxidrome

A
  • blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone
    • hyperthermia
    • dry, flushed skin
    • dilated pupils
    • agitation, hallucinations, delirium
    • tachycardia: earliest and most reliable sign
    • urinary retention
    • decreased bowel sounds
34
Q

causes of anticholinergic toxidrome

A
  • antihistamines
  • jimson weed
35
Q

control agitation in anticholinergic toxidrome with

A

benzodiazepines

36
Q

antidote for anticholinergic toxidrome

A

physostigmine

37
Q

what is the toxidrome

  • hyperthermia
  • tachycardia
  • HTN
  • diaphoresis
  • agitation, hallcination, paranoia
  • dilated pupils
  • sz
A
  • sympathomimetic toxidrome
38
Q

list the causes of sympathomimetic toxidrome

A
  • cocaine
  • amphetamines
  • ephedrine
  • pseudoephedrine
  • bath salts
  • theophylline
  • caffeine
39
Q

tx of sympathomimetic toxidrome

A

benzodiazepine

40
Q

what is a big difference between anticholinergic and sympathomimetic toxidromes

A
  • anticholinergic: dry skin
  • sympathomimetic: diaphoresis
41
Q

what is the toxidrome

  • hypothermia
  • bradycardia
  • hypotension
  • bradypnea/apnea
  • pulmonary edema
  • CNS depression/ coma
  • miosis
A

opioid toxidrome

42
Q

causes of opioid toxidrome

A
  • opioids: heroin, morphine, oxycodone
  • diphenoxylate
43
Q

what is the toxidrome

  • hypothermia
  • vitals normal
  • bradypnea/apnea
  • CNS depression
  • hyporeflexia
  • variable pupils
A

sedative-hypnotic toxidrome

44
Q

causes of sedative-hypnotic toxidrome

A
  • benzodiazepines
  • barbituates
  • GHB
  • carisoprodol
  • alcohols
  • zolpidem

emergency medicine (3 decks)

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