AMS Flashcards
Most common cause of NMS
Haloperidol
Tx for acute dystonia
Diphenhydramine IV 25-50 or
IM or IV benztropine 1-2
Lithium side effect to remember
Nephrogenic DI
Side effects of haloperidol to remember
Prolonged QT;
Parkinsonism;
Akathisia;
Acute dystonia
Ocular effects of PCP
Vertical nystagmus
Ocular effects of cocaine
Dilated pupils
Ocular effects of amphetamines
Dilated pupils
Ocular effects of MS
Internuclear ophthalmoplegia
Time to peak effect of IM haldol
30 min
Typical dosing of haldol
5-10mg every 10-30 min
Does haldol cause respiratory depression?
No
Does thioridazine cause respiratory depression?
Yes
Management of patients who continue to struggle with physical restraints:
Chemical sedation
Why chemically sedate pts who continue to struggle with physical restraints?
To prevent a life-threatening metabolic acidosis
Cocktail for the agitated patient
Haldol 5mg
Lorazepam (Ativan) 2mg
q30 min PRN;
use half doses in the elderly
Hypopnea
Cyanosis
Miotic pupils;
toxidrome?
Opiate toxidrome
Why avoid flumazenil in AMS?
Can precipitate withdrawal and seizures in chronic benzo users
Isopropyl alcohol is metabolized to:
Acetone –> non-anion gap metabolic acidosis
Labs from salicylates show:
anion gap metabolic acidosis with superimposed respiratory alkalosis
Causes of increased anion gap metabolic acidosis:
CATMUDPILES Cyanide Alcoholic ketoacidosis Toluene Methanol Uremia Diabetic Ketoacidosis Paraldehyde Isoniazid/Iron Lactate Ethylene glycol Salicylaites
Rapid lowering of the BP in eclampsia can result in:
Uterine hypoperfusion
When is antihypertensive therapy indicated in eclampsia?
If DBP>110 after seizures are controlled
Control eclamptic seizures with:
Magnesium sulfate
Initial therapy for status epilepticus
Initial medical therapy for status epilepticus is with benzodiazepines (e.g., lorazepam, diazepam) with the addition of either levetiracetam, phenytoin or fosphenytoin, or valproic acid
