AMS and concussion Flashcards
list the risk factors for AMS
- age > 60
- alcohol or drug addiction
- hx of brain injury
- dementia
- > 3 medications
what stage of AMS is this:
- a state in which pt is not fully alert and tends to drift off to sleep when not actively stimulated
lethargic or somnolence
what stage of AMS is this:
- difficult to arouse, when aroused - confused
obtunded
what stage of AMS is this:
- patient responds to only persistent and vigorous stimulation
stupor or semicoma
evaluation and management of AMS involves what first steps
- address ABCs
- rapid initial assessment
- start interventions
*pay close attention to vital signs
List elements of ABC
- ABC(D)
- establish or protect airway
- supplemental oxygen
- assess circulatory status
- pulses
- direct pressure over bleeding
- assess dextrose (fingerstick)
What is included in Coma cocktail
- thiamine
- D50
- Naloxone
when is coma cocktail given? if patient awakens in 2-3 min, what is the likely diagnosis
- give if unconcious and unresponsive with no history
- likely either hypoglycemia or opiate OD
fruity breath odor is consistent with
- DKA
- nitrites
- isopropyl alcohol
“bitter almonds” breath odor is consistent with
cyanide
“rotten eggs” breath odor is consistent with
hydrogen sulfide
oil or gasoline breath odor is consistent with
hydrocarbons
odorless but fluorescent green breath is consistent with
ethylene glycol
what is one way to differentiate between organic states and psychotic states of AMS
- orientation to person may be as altered as to time and place in psychiatric but rare in organic
- psychotic patients usually retain recent memory and are able to perform single calculations (rarely preserved in organic states)
what do hallucinations tend to be in psychotic vs metabolic
- psychotic: auditory
- metabolic: visual
clinical presentation
- acute onset of fever, bleeding/rash, renal failure, neurologic changes
- commonly affects women 20-40 yo
- thrombotic thrombocytopenia purpura
etiology of thrombotic thrombocytopenia purpura
- inhibition of the enzyme ADAMTS13, responsible for cleaving von Willebrand factor (vWF)
- The increase in circulating multimers of vWF increase platelet adhesion to areas of endothelial injury
treatment of thrombotic thrombocytopenia purpura
- plasma exchange and steroids
NEXUS criteria: CANNOT clear C-spine if
- intoxication
- distracting injuries
- midline posterior point tenderness
- AMS
- focal neurological deficits
most helpful diagnostic study to evaluate acute head trauma
CT
if spincter tone intact, injury is likely . if little or no tone, there is
- intracranial
- coexisting spinal cord injury
most common cause of AMS
- neurological
define mild TBI
- head injury due to contact or acceleration/decelaration forces
- GCS 13-15, 30 min after injury
why are imagining studies mostly normal in concussions
- concussion usually reflext a functional disturbance rather than a structural injury
most common cause of TBI in young and elderly
- young: MVA
- elderly: falls
hallmark symptoms of concussion
- confusion
- amnesia
- both usually appear immmediately after injury
- loss of memory for traumatic event but sometimes retrograde or anterograde as well
- +/- loss of consciousness
if a seizure occurs within the first hour after injury it is likely to be , after the first hour it is usually
- generalized
- focal
seizures may occur up to how long after a concussion
- may occur within the first week after injury
- usually associated with moderate TBI
The westmead post-traumatic amnesia scale. any incorrect response to what number of questions is positive for cognitive impairment after head injury? what is the evaluation?
- 1
- what is your name?
- What is the name of this place
- why are you here
- what month are we in
- what year are we in
- in what town are you in
- how old are you
- what is your date of birth
- what time of day is it
canadian CT head rule
- GCS < 15 two hours after injury
- suspected open or depressed skull fx
- any sign of basilar skull fx
- two or more episodes of vomiting
- > 65 yo
- amnesia before impact of > 30 min
- dangerous MOI
New orleans CT head rule
- Same as Canadian +
- drug or alcohol intoxication
- trauma above clavicle
observation is recommended for how long after a mild TBI for obsrve for intracranial complications
- at least 24 hours
when should you hospitalize a pt with TBI
- GCS < 15
- abnormal CT
- Sz
- abnormal bleeding parameters or on oral anticoagulation
outpatient observation okay for pts with TBI who
- GCS > 15
- normal exam
- normal head CT
post concussion syndrome
- headache
- dizziness
- mild cognitive impairment
second impact syndrome
diffuse cerebral swelling occuring after a second concussion
anosmia
the loss of the sense of smell
DDX of post traumatic vertigo
- cochlear and/or vestibular structure damage
- benign paroxysmal positional vertigo
- perilymphatic fistula
if diplopia is developed after TBI, most common CN to fail is
- CN IV
- followed by CN VI
chronic traumatic encephalopathy
- repeated concussions may cause cumulative deficits with impairment in congintion and/or changes in behavior, personality, or gait
- football players, boxers
- inc risk of alzheimers
when should player be allowed to play after concussion
- should not until all symptoms have resolved
- six-day graduated return to play protocol
- step-wise increase in activity with evaluation is done
