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clin med III, exam 3 > AMS and concussion > Flashcards

AMS and concussion Flashcards

1
Q

list the risk factors for AMS

A
  • age > 60
  • alcohol or drug addiction
  • hx of brain injury
  • dementia
  • > 3 medications
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2
Q

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
A

lethargic or somnolence

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3
Q

what stage of AMS is this:

  • difficult to arouse, when aroused - confused
A

obtunded

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4
Q

what stage of AMS is this:

  • patient responds to only persistent and vigorous stimulation
A

stupor or semicoma

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5
Q

evaluation and management of AMS involves what first steps

A
  1. address ABCs
  2. rapid initial assessment
  3. start interventions

*pay close attention to vital signs

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6
Q

List elements of ABC

A
  • ABC(D)
    • establish or protect airway
    • supplemental oxygen
    • assess circulatory status
      • pulses
      • direct pressure over bleeding
    • assess dextrose (fingerstick)
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7
Q

What is included in Coma cocktail

A
  • thiamine
  • D50
  • Naloxone
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8
Q

when is coma cocktail given? if patient awakens in 2-3 min, what is the likely diagnosis

A
  • give if unconcious and unresponsive with no history
  • likely either hypoglycemia or opiate OD
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9
Q

fruity breath odor is consistent with

A
  • DKA
  • nitrites
  • isopropyl alcohol
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10
Q

“bitter almonds” breath odor is consistent with

A

cyanide

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11
Q

“rotten eggs” breath odor is consistent with

A

hydrogen sulfide

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12
Q

oil or gasoline breath odor is consistent with

A

hydrocarbons

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13
Q

odorless but fluorescent green breath is consistent with

A

ethylene glycol

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14
Q

what is one way to differentiate between organic states and psychotic states of AMS

A
  • 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)
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15
Q

what do hallucinations tend to be in psychotic vs metabolic

A
  • psychotic: auditory
  • metabolic: visual
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16
Q

clinical presentation

  • acute onset of fever, bleeding/rash, renal failure, neurologic changes
  • commonly affects women 20-40 yo
A
  • thrombotic thrombocytopenia purpura
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17
Q

etiology of thrombotic thrombocytopenia purpura

A
  • 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
18
Q

treatment of thrombotic thrombocytopenia purpura

A
  • plasma exchange and steroids
19
Q

NEXUS criteria: CANNOT clear C-spine if

A
  • intoxication
  • distracting injuries
  • midline posterior point tenderness
  • AMS
  • focal neurological deficits
20
Q

most helpful diagnostic study to evaluate acute head trauma

A

CT

21
Q

if spincter tone intact, injury is likely . if little or no tone, there is

A
  1. intracranial
  2. coexisting spinal cord injury
22
Q

most common cause of AMS

A
  • neurological
23
Q

define mild TBI

A
  • head injury due to contact or acceleration/decelaration forces
  • GCS 13-15, 30 min after injury
24
Q

why are imagining studies mostly normal in concussions

A
  • concussion usually reflext a functional disturbance rather than a structural injury
25
Q

most common cause of TBI in young and elderly

A
  • young: MVA
  • elderly: falls
26
Q

hallmark symptoms of concussion

A
  • confusion
  • amnesia
    • both usually appear immmediately after injury
    • loss of memory for traumatic event but sometimes retrograde or anterograde as well
  • +/- loss of consciousness
27
Q

if a seizure occurs within the first hour after injury it is likely to be , after the first hour it is usually

A
  1. generalized
  2. focal
28
Q

seizures may occur up to how long after a concussion

A
  • may occur within the first week after injury
  • usually associated with moderate TBI
29
Q

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?

A
  • 1
  1. ​what is your name?
  2. What is the name of this place
  3. why are you here
  4. what month are we in
  5. what year are we in
  6. in what town are you in
  7. how old are you
  8. what is your date of birth
  9. what time of day is it
30
Q

canadian CT head rule

A
  • 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
31
Q

New orleans CT head rule

A
  • Same as Canadian +
    • drug or alcohol intoxication
    • trauma above clavicle
32
Q

observation is recommended for how long after a mild TBI for obsrve for intracranial complications

A
  • at least 24 hours
33
Q

when should you hospitalize a pt with TBI

A
  • GCS < 15
  • abnormal CT
  • Sz
  • abnormal bleeding parameters or on oral anticoagulation
34
Q

outpatient observation okay for pts with TBI who

A
  • GCS > 15
  • normal exam
  • normal head CT
35
Q

post concussion syndrome

A
  • headache
  • dizziness
  • mild cognitive impairment
36
Q

second impact syndrome

A

diffuse cerebral swelling occuring after a second concussion

37
Q

anosmia

A

the loss of the sense of smell

38
Q

DDX of post traumatic vertigo

A
  • cochlear and/or vestibular structure damage
  • benign paroxysmal positional vertigo
  • perilymphatic fistula
39
Q

if diplopia is developed after TBI, most common CN to fail is

A
  • CN IV
  • followed by CN VI
40
Q

chronic traumatic encephalopathy

A
  • 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
41
Q

when should player be allowed to play after concussion

A
  • should not until all symptoms have resolved
  • six-day graduated return to play protocol
    • step-wise increase in activity with evaluation is done

clin med III, exam 3 (6 decks)

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