Approach to AMS Flashcards
What are the ABCDEs?
Airway Breathing Circulation Disability (GSC scale) Expose (fully undress)
What are the 6 things that all patients with AMS need, besides ABCs?
- Cardiac monitor
- Pulse ox / oxygen
- POC Glucose
- IV access
- Trauma eval
- Naloxone if narcotic overdose
What is a classic cause of AMS in the winter months, that causes a HA and patients to get better when they’re in the ED without any intervention?
Carbon Monoxide
What are the five major CNS causes of AMS?
- Tumor
- Hemorrhage
- Edema
- Seizure
- Dementia
What are the four major broad causes or systems that are associated/cause AMS?
- CNS
- Metabolic
- Infectious
- Pharmacologic/toxic
What are three major primary CNS infectious processes that can cause AMS?
- Meningitis
- Encephalitis
- Abscesses
What are the components of the AEIOU TIPS mnemonic for causes of AMS?
Alcohol Epilepsy Insulin Oxygen/opiates Uremia Trauma and temp Infection Poisons/psychogenic Shock/stroke
Categorize delirium, dementia, and psychosis in terms of: onset
Delirium = rapid Dementia = slow Psychosis = variable
Categorize delirium, dementia, and psychosis in terms of: course of symptoms
Delirium = fluctuating Dementia = progressive Psychosis = variable
Categorize delirium, dementia, and psychosis in terms of: level of consciousness
Delirium = Altered Dementia = normal Psychosis = variable
Categorize delirium, dementia, and psychosis in terms of: presences of hallucinations and/or what type
Delirium = Visual hallucinations (related to external stimuli) Dementia = None (usually) Psychosis = auditory (related to internal stimuli)
Categorize delirium, dementia, and psychosis in terms of: physical exam findings (normal vs abnormal)
Delirium = abnormal Dementia = normal Psychosis = normal
Categorize delirium, dementia, and psychosis in terms of: Prognosis
Delirium = poor if cause not tx Dementia = progressive Psychosis = variable
Categorize delirium, dementia, and psychosis in terms of: general cause (organic vs functional)
Delirium = organic Dementia = organic Psychosis = functional
Categorize delirium, dementia, and psychosis in terms of: vital signs (normal vs not)
Delirium = Not normal Dementia = normal Psychosis = normal
What parts of the brain are responsible for arousal and cognition respectively?
- Arousal = reticular activating system
- Cognition = cortices
What is the appropriate way to approach a patient who you think haves psychosis?
R/o medical etiology first, then ship to psych if needed
What cause of AMS has a good chance of affecting both the elderly and the young?
Polypharmacy
Why is a complete exam of the skin in the AMS patient always indicated?
Fentanyl patches or infection sites
What are the total score values for each of the Glasgow Coma scale areas?
EYES = 4 MOUTH = 5 ARM/LEG = 6
What are the components and scores for the eye portion of the GSC?
4 = spontaneously 3 = loud voice 2 = To pain 1 = None
What are the components and scores for the verbal portion of the GSC?
5 = oriented 4 = confused 3 = inappropriate words 2 = incomprehensible sounds 1 = no sounds
What are the components and scores for the motor portion of the GSC?
6 = follows commands 5 = localizes to pain 4 = withdraws to pain 3 = abnormal flexion 2 = abnormal extension 1 = none
What GSC score is an “indication” for intubation?
“less than 8, intubate”, although this has not been proven or studied. If a patient is declining fast, intubate
Decreased level of consciousness with cranial nerve findings is a (___) lesion until proven otherwise.
Decreased level of consciousness with cranial nerve findings is a brainstem lesion until proven otherwise.
What are you looking for with a GU/GI exam in the patient presenting with AMS?
GU = anuric --> uremic encephalopathy GI = bleeding, infx
Petechiae in the pt with AMS should raise suspicion for what?
Meningococcal meningitis
What is the appropriate imaging to use if you suspect a lesion in the brainstem? (CT or MRI)?
MRI
