AMS & Toxicology

Question 1

Not fully alert

drifts to sleep

limited awareness

loses train of thought

Answer 1

Lethargic/somnolent

Question 2

difficult to aroused

confused when aroused

stimulation required to elicit minimal cooperation

Answer 2

obtunded

Question 3

doesn’t rouse spontaneously

vigorous stimulation for very little response

moan or mumble when aroused

Answer 3

stuporous/semicomatose

Question 4

unarousable unresponsiveness…

Answer 4

coma

Question 5

minimum GCS even if dead…

Answer 5

3

Question 6

GCS scoring…

Answer 6

Eye: 1-4

Motor: 1-6

Verbal: 1-5

Question 7

What posturing?

flexion w. adduction of arms and extension of legs

(flexor posturing)

Answer 7

decorticate

COR - hands over heart

Question 8

This type of posturing a/w corticospinal lesion (cortex to upper midbrain)

Answer 8

decorticate

Question 9

What posturing?

extension, adduction, internal rotaion of arms and leg extension

(extensor posturing)

Answer 9

Decerebrate

Question 10

Decerebrate posturing is associated with damage where?

Answer 10

brainstem (pons, upper medulla)

Question 11

Which is worse, decorticate or decerebrate?

Answer 11

decerebrate

Question 12

Dementia (or Major Neurocognitive Disorder) has significant cognitive impairment in 1 of 6 domaines…

Answer 12

learning/memory

language

executive function

complex attention

perceptual motor function

social cognition

Question 13

A fluctuating disturbance in attention and awareness and cognition developing over a short period of time…

Answer 13

delerium

Question 14

are focal or lateralized neuro findings characteristic of delerium?

Answer 14

no

Question 15

MOVE STUPID describes what etiology of AMS

Answer 15

metabolic
oxygen
vascular
endocrine

seizure
trauma
uremia
psych
infx
drugs

Question 16

initial lab workup for AMS

Answer 16

lytes
Cr
Glucose
Ca
CBC
UA
Urine Preg

Question 17

What diagnostic for AMS?

CAD hx or age > 50

Answer 17

ECG

Question 18

What diagnostic for AMS?

resp sxs
fever

Answer 18

CXR

Question 19

What diagnostic for AMS?

focal neuro exams

hx of trauma

Answer 19

Head CT

Question 20

What diagnostic for AMS?

hypoxic

suspected metabolic acidosis

Answer 20

ABGs

Question 21

3 tx options that pose little harm in tx of AMS

Answer 21

thaimine
dextrose
naloxone

Question 22

Physical restraints should be used when with AMS?

Answer 22

last resort

Question 23

What 3 things can lessen disruptive behavior in AMS?

Answer 23

frequent reassurance, touch, verbal orientation

Question 24

Haloperidol should be reserved for…

Answer 24

potential harm to patient, providers, family

Question 25

BZs as a tx for undifferentiated AMS?

Answer 25

no

Question 26

are cholinesterase inhibitors effective in tx of delerium?

Answer 26

no

Question 27

When can BZs be considered for AMS?

Answer 27

withdrawal sympathomimetic/anticholinergic poisoning

Question 28

delirium may take _____ to resolve

Answer 28

weeks to months

Question 29

4 important questions for toxicology hx?

Answer 29

which toxin? how much? when? precipitating event?

Question 30

Cholinergic like organophosphates cause physiologic ______

Answer 30

depression

Question 31

The below are examples of what kind of decon? * Forced diuresis * Urine ion trapping * Hemodialysis * Exchange transfusion

Answer 31

enhanced elimination

Question 32

Amitriptyline antidote

Answer 32

sodium bicarb

Question 33

anticholinergic antidote

Answer 33

physostigmine

Question 34

beta blocker antidote

Answer 34

glucagon

Question 35

cyanide antidote

Answer 35

hydroxocobalamin/nitrates

Question 36

hydrofluoric acid antidote

Answer 36

calcium

Question 37

iron antidote

Answer 37

desferrioxamine

Question 38

methanol/ethylene glycol antidote

Answer 38

ethanol

Question 39

methemoglobin antidote

Answer 39

methyline blue

Question 40

organophosphates/anticholinesterase antidote

Answer 40

atropine, 2-PAM

Question 41

salicylate antidote

Answer 41

urine alkalization, dialysis

Question 42

sulfonylurea antidote

Answer 42

octreotide

Question 43

Urine or serum tests? * Opioids * Benzos * Cocaine * THC * Barbiturates * Amphetamines/methamphetamines * TCAs * Buprenorphine

Answer 43

urine

Question 44

urine or serum tests? * Acetaminophen * Salicylate * Carboxyhemoglobin * Digoxin * Lithium * Iron, lead, mercury * Ethylene glycol * Antiepileptic drugs

Answer 44

Serum

Question 45

4 labs for all poisonings and patients w. AMS

Answer 45

preg glucose acetaminophen/salicylate testing

Question 46

Cholinergic toxidrome sxs: SLUDGE and Killer BBBs

Answer 46

``` Salivation Lacrimation Urination Defecation GI distress Emesis ``` Bradycardia, Bronchorrhea. Bronchospasm

Question 47

Cholinergic toxidrome tx...

Answer 47

agressive decon atropine + 2 PAM

Question 48

Anticholinergic toxidrome drugs (2)

Answer 48

antihistamines | jimson weed

Question 49

Earliest and most reliable sign of anticholinergic toxidrome...

Answer 49

tachycardia

Question 50

Tx of anticholinergic poisoning...

Answer 50

BZs for agitation Activated charcoal if recent Physostigmine

Question 51

What toxidrome? * Hyperthermia * Tachycardia/dysrhythmia * HTN * Diaphoresis * Agitation, hallucinations, paranoia * Dilated pupils * Seizures (

Answer 51

sympathomimetic

Question 52

How can you tell sympathomimetic vs anticholinergic?

Answer 52

anticholinergic = dry skin, hypoactive BS Sympathomimetic = diaphoresis, hyperactive BS

Question 53

Which toxidrome? * Hypothermia * Vitals usually relatively normal * Bradypnea/apnea * CNS depression, coma * Hyporeflexia * VARIABLE pupils

Answer 53

sedative hypnotic

Question 54

Tx for sedative hypnotics...

Answer 54

time +/- flumazenil