Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nayla Foundations Exam 4 > AMS > Flashcards

AMS Flashcards

1
Q

What does AOx4 mean

A

Alert: LOC and response to stimuli
Oriented: to person, place, and time +/- situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If LOC is impaired, what is it due to

A

bilateral cerebral dysfunciton (oriented) OR

reticular activating system (Alert)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the levels of consciousness

A 
Alert
Lethargic/somnolent 
obtunded
stuprose
coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is delerium

A

Acute (hr-day) disturbance in attention and cognitive disturbance that is a direct physiological consequence of another medical condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Delerium RF include

A 
Age
male
dementia
Hx high alcohol consumption 
sensory impairments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can cause delerium

A 
Infection 
Withdrawal 
Acute vasculae 
Trauma 
CNS lesion 
Hypoxia 
Deficiency of vitamins 
Endocrine 
Acute metabolic 
Toxins 
Heavy metals 
(also fecal impaction, bed rest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Effective delerium management should include

A

Prevention: avoid causes
ID & TX: infection, pain, fluid balance, sensory deprivation
Maintain behavior: sitter, reorient, reassure, music (NO RESTRAINTS)
Prevent complication: falls, malnutrition, pressure ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What med can be used to maintain control

A

IF necessary, Haloperidol

*black box- increase mortality in elderly with dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should you avoid to decrease risk of delerium

A 
alcohol
antipsychotics
benzos
opioids
anticholinergics
H2 blockers (ppi)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does AMS present

A

confusion, lethargy, inattention, agitation, impulsivity, delusions, hallucination, sedation, change in behavior or personality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of dementia include

A 
Drugs 
Electrolytes (Hyponatremia)
Metabolic
Emotional/psych 
Neuro/nutrition
Trauma, tumor, temp
Infection
Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hypercalcemia is

A

cancer intil proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When finding metabolic causes, look for

A

DM
thyroid disease
cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neuro Sx in AMS include

A

dysphasia
dysarthria
unilateral facial droop and decreased strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are trauma, temp, and tumor signs

A

Concussion (protect Spine with c collar)
CT Head and c spine
rectal exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can a rectal exam tell you

A

Sphincter intact= intracranial etiology

no rectal tone= spinal cord injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is hypothermia

A

skin <91 = peripheral vasoconstriction, shivering, AMS, changes in cardiac and pulmonary
86-92 = apathy, lethargy, ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is heat exhaustion

A

core temp 106 or below = orthostatic hypotension, tachy, diaphoresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is heat stroke

A

> 106 degrees = tachy, diaphoresis, orthostatic hypotension AND CNS dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What infections are common in age extremes

A

elderly: UTI, PNA
infant: meningitis
(may not be febrile)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Acute intoxication causes

A

metabolic encephalopathy similar to sedative hypnotics
Tachycardia + hypotension + hypothermia
(BAL 300= coma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do you attribute AMS to psych causes

A

when you have r/o stroke, mass lesion, confusion, and delerium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you evaluate AMS

A

ABC (and glucose)- vitals, mental status, pupil size, skin temp, HR, O2
Start interventions
Then complete H&P to determine cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you treat AMS

A 
ID cause, Treat cause 
in the meantime; SNOT cocktail 
Sugar 
Naloxone (narcan) 
Oxygen
Thiamine (give before glucose)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is poisoning

A

predictable, dose dependent effects with a harmful agent

(usually accidental in kids 1-5)- intentional in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the MCC of toxic exposures

A 
accidental ingestion (kids)
accidental OD (elderly)
intentional OD (suicide)
secondary to psych disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

History “matters” when determining cause

A 
Material inhaled, ingested, or absorbed
Amount taken
Time Taken
Emesis
Reason
S/Sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Working in a garage often causes

A

CO poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Applying chemicals to crops often causes

A

organophosphate poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PE for poisoning will show 1 of two effects

A 
Psychologic excitation (high HR, BP, RR, T) 
Physiologic depression (low HR, BP, RR, T)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What causes physiologic excitation

A 
Anticholinergics 
Sympathomimetics 
Central hallucinogens 
Drug withdrawal 
(coke, meth, bath salts, PCP, LSD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What causes physiologic depression

A 
EtOH
Sedative hypnotics 
Opiates 
Cholinergics 
Sympatholytics 
Toxic alcohols 
Ethylene Glycol
(organophosphates, benzos, pain meds, methanol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What will show mixed physiologic effects

A 
Polydrug OD
Metabolic poisons
Heavy metals 
TCA
(metformin, sulfonylurea, ASA, cyanide, iron)
34
Q

What 2 physical exam findings can tell you a lot

A

pupil size, mydriatic or miotic

EOM’s, nystagmus

35
Q

What labs should you get for diagnosis

A 
CBC
Anion gap and MUDPILES 
BUN, CR
Glucose
LFT
B-HCG
36
Q

What shows up on a urine drug screen

A 
opioids
benzo
coke
thc
barbituates
amphetamines
TCA
buprenorphine
37
Q

What do you need a serum screening for

A 
APAP 
ASA
digoxin
lithium
valporic acid
iron, lead, mercury
38
Q

What is a toxidrome

A

clinical syndrome essential to recognize poison pattern (s/Sx of a certain class)

39
Q

What is general therapy for all poisoning

A 
ABC 
Gastric lavage (before activated charcoal if ingestion <60 min prior and airway is protected)
40
Q

When would you preform hemodialysis for poison therapy

A 
amphetamines 
lithium
methanol
ASA
theophylline
phenobarbital 
ethylene glycol
41
Q

How do you treat different poisons

A

inhaled: Oxygen
Contaminated eyes: irrigation
Contaminated skin: water and dilute soap
Ingested: gastric lavage (NGT, OGT, PO charcoal)

42
Q

What poison control numbers should you call

A

American Association of Poison Control Centers (1.800.222.1222)
Banner Poison Control Center (602.253.3334)

43
Q

What is a concussion

A

traumatic biomechanical force (+/- head trauma) causing rapid onset neuro dysfunction that resolves spontaneously
+/- LOC, no imaging abnormalities

44
Q

Who is most likely to sustain TBI

A 
0-4 y/o
15-19 y/o
65+ 
75+ have highest rates of TBI death 
Males
Soldiers from Iraqi war
45
Q

Majority of sports injuries occur due to

A

Football!

also hockey, soccer, rugby

46
Q

What is damage in a concussion due to

A

axonal injury from coup-contra coup

head back/brain forward- head forward/brain back

47
Q

What are symptoms of a concussion

A 
Confusion (answers slowly)
memory loss 
visual disturbance (diplopia, photophobia)
Impaired balance 
headache
48
Q

Post concussive syndrome is

A

when symptoms last >1 week with cognitive difficulties and a cluster of physical and sleep symptoms

49
Q

How do you diagnose concussion

A

clinically- CT only if LOC or GCS <15, or serious injury

50
Q

What is different about athletes and concussions

A

they need to be evaluated by experienced clinicians (SCAT5) with specific protocol to return to play

51
Q

What is the Brain Trauma Indicator

A

new lab test that measures proteins (UCH-LI and GPAP) released from the brain into blood w/in 12 hours of injury (Predicts patients that will show intracranial lesions on CT)

52
Q

What is Tx for concussion

A

physical and mental rest + APAP

gradually increase activity

53
Q

What is an EDH

A

blood accumulates between the dura and bone (IC or spinal)

54
Q

When is an EDH an emergency (fatal)

A

if intracranial !

55
Q

What is the pathophys of an EDH

A

linear force to skull causes periosteal dura to separate from bone= vessel damage
usually skull Fx

56
Q

Does expansion stop?

A

it is rapid, but stops at suture lines

57
Q

What are symptoms of an EDH

A

delayed decline
ALC, HA, N/V, Sz, focal neuro deficits (aphasia, weakness, numbness)
Spinal EDH: weakness, change in DTR, sensory deficit with radicular paresthesias, bladder and bowel dysfunction

58
Q

What will EDH PE show

A

increased ICP (bradycardia, HTN)
skull Fx
Hematoma
raccoon eyes (basilar skull Fx)
battle sign
CSF otorrhea and rhinorrhea, hemotympanum
Decerebrate, decorticate, altered GCS, weakness, Doll eye (oculocephalic reflex), anisocoria (ipsilat dilation), CN VII injury

59
Q

Common brain herniations include

A

*Subfalcine (HA, contralateral leg weakness)
Tonsillar (obtunded)
Transtentorial (CN III ipsilat abn EOM and pupil/ contrala hemiparesis)

60
Q

What are symptoms of a brain herniation

A

increased ICP causing Cushing’s triad

HTN, resp depression, bradycardia

61
Q

EDH workup includes

A

CBC
Coags
Tox screen
type and screen (ab-ag for blood transfusion)

62
Q

What will EDH CT show

A

midline shift- white aint right

LENS shaped

63
Q

What is Tx for EDH

A

Emergent decompression (burrhole on side of DILATD pupil/injured side)
Elevate head 30-45
+/- coagulopathy (FFP, Vitamin K, protamine)

64
Q

How can you treat an intubated EDH patient

A

Hyperventilate = hypocapnia = vasoconstriction = decrease ICP
*but, you increase ischemia

65
Q

What meds can you use for an EDH

A

Diuretics (mannitol) or Hypertonic saline (for high ICP)
Tylenol to decrease fever
anticonvulsants for prophylaxis

66
Q

What med can you give for a spinal EDH

A

high dose methylprednisone

67
Q

What is the definitive Tx for EDH

A

Surgery; craniotomy or laminectomy to evacuate hematoma

68
Q

What is a SDH

A

blood below inner dural layer, extending to brain and arachnoid

69
Q

How can you categorize SDH

A

Acute <72 hours
Subacute 3-7 days
Chronic >7 days

70
Q

Who often gets SDH

A

Elderly on anticoags
s/p LP
Spontaneous

71
Q

What is the MOA of SDH

A

coup-contre coup: torn vessels (bridging veins) that connect surface of brain to dural sinus
Chronic SDH related to cerebral atrophy

72
Q

What can an SDH lead to

A

Herniation

small SDH resolve spontaneously

73
Q

How does Acute SDH present

A

mod-severe injury
comatose
presentation depends on location

74
Q

How does chronic SDH appear

A

insidious in 40+ y/o (older brain= more atrophy)

decreased LOC, HA, gait abn/imbalance, memory loss, personality changes, motor deficits, aphasia, seizure

75
Q

What does a SDH PE show

A 
GCS <15 with blunt head trauma (GET A CT) 
HA 
confusion
nausea
speech difficulty 
diplopia
weakness
76
Q

What does a SDH workup include

A

emergent non-con CT (when patient is stabilized)
If GCS worsens by 2+ points, repeat imaging
labs (same as EDH; CBC, coags, tox screen, type and screen)

77
Q

MRI or CT for SDH

A

MRI is better, but CT is faster and more available

78
Q

What does an acute SDH show on CT

A

CRESCENT shaped mass (white aint right) (hyperdense)

-chronic SDH is darker (isodense) and harder to see on CT

79
Q

How do you treat an acute SDH

A

ABC
osmotic diuretic
surgical decompression

80
Q

What is the prognosis of Acute SDH

A

poor; due to likely brain injury

81
Q

Why do Acute SDH patients need ICU post op

A

strict BP control (dont want it to be too high and have them bleed again)
ventilator respiration

82
Q

What is Tx for chronic SDH

A

surgery not needed w/o mass effect or symptoms

Nayla Foundations Exam 4 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions