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OCHT Term III > Differential Diagnosis - Altered LOA > Flashcards

Differential Diagnosis - Altered LOA Flashcards

1
Q

What categories fall under A (of AEIOU TIPS) (3)

A

Alcohol

Acidosis

Arrhythmia

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2
Q

How does alcohol alter LOA?

A
  • alters the level of NTs
  • suppresses the release of some excitatory NTs (slows down transmissions of glutamate which typically increases brain activity and energy levels)
  • increases effects of inhibitory NTs (i.e. GABA)
  • also increases dopamine
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3
Q

How does acidosis/alkalosis (metabolic or respiratory) cause altered LOA?

A
  • affects PCO2 (bicarbonate levels) which affects pH-dependent enzymatic functions
  • metabolic acidosis is always accompanied by neurologic manifestations
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4
Q

How do arrhythmias cause altered LOA?

A
  • If blood cannot be pumped efficiently from the heart, it may pool and clot which cuts off blood flow to the heart, brain and other organs
  • ex. SVT, WPW, 3rd degree block, MIs (that can be caused by blocks)
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5
Q

COPD lead to ketoacidosis is an example of which category?

A

acidosis

COPD can also fall under “oxygen - O” of AEIOU TIPS

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6
Q

What categories fall under E (of AEIOU TIPS)?

A

Endocrine

electrolytes

encephalotpathy

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7
Q

How does endocrine-related conditions cause altered LOA?

A
  • endocrine system is made up of a network of glands that secrete hormones to regulate bodily functions
  • In the brain, hypothalamus produces releasing and inhibiting hormones which stop and start the production of other hormones throughout the body (HR and BP)
  • changes in hormone levels can cause changes in awareness (homeostasis altered)
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8
Q

How do electrolyte imbalances cause altered LOA?

A

electrolytes like sodium, potassium, calcium affect cardiac function and neuron firing so changes would cause alterations to regular function = altered LOA

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9
Q

What does encephalopathy mean and how does it cause altered LOA?

A

Means “damage or disease that affects the brain”

changes how the brain and thus body operates, leading to altered LOA

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10
Q

Cancer/hypothyroidism can fall under which category?

A

endocrine

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11
Q

Alcohol intoxcation/toxic ingestion call fall under which category of AEIOU TIPS?

A

alcohol

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12
Q

Dehydration/vomiting can fall under which category?

A

electrolytes

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13
Q

Hyperkalemia can fall under which category?

A

electrolytes

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14
Q

What category falls under the first “I” in AEIOU TIPS?

A

Insulin

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15
Q

Encephalitis, meningitis, and tumors would fall under which category of AEIOU TIPS?

A

encephalopathy

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16
Q

How do insulin-related emergencies cause altered LOA?

A

Conditions like hypoglycemia are characterized by inability for cells to have the fuel they need to perform necessary functions; leads to altered LOA

prolonged hyperglycemia (DKA) can cause metabolic acidosis (because lack of appropriate amount or use of insulin to take up glucose)

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17
Q

What categories call under O of AEIOU TIPS? (2)

A

Oxygen

Overdose

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18
Q

How do changes in oxygen levels cause altered LOA?

A

insufficient O2 causes loss of approprirate cellular function

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19
Q

How do overdoses cause altered LOA?

A

dependent on the drugs - involves various mechanisms that can lead to altered LOA (ex. opioids - resp depression)

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20
Q

Hypovolemic shock can fall under which category of AEIOU TIPS?

A

oxygen - O

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21
Q

What category/categories fall under U of AEIOU TIPS?

A

uremia

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22
Q

How may uremia-related changes cause altered LOA?

A

ex. conditions like renal failure which can cause uric acid buildup in the blood can lead to metabolic acidosis (which leads to altered LOA)

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23
Q

What categories fall under T in AEIOU TIPS?

A

Trauma

Tumour

Thermal

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24
Q

How would trauma cause altered LOA?

A

lol seems intuitive

  • trauma can cause increased ICP, decreases perfusion altering LOA
  • hypovolemia as a result of trauma can affect oxygen, acid/base balance, and electrolyte balance
25
Q

How would tumours cause changes in LOA?

A

similar mechanisms to encephalopathy - LOA alteration depends on location of tumour

26
Q

How do changes in body temperature (thermal-related emergencies) cause altered LOA?

A

changes metabolic rate, affects cerebral blood flow potentially altering mental status

27
Q

What category/categories fall under second “I” of AEIOU TIPS?

A

Infection

28
Q

How does infection cause altered LOA?

A

Infection causes inflammation of the neurons, inhibiting normal neuron and cell function

29
Q

UTI causing alterations in LOA fall under which category?

A

Infection - I

30
Q

What category/categories fall under P in AEIOU TIPS?

A

Poisoning

Psychiatric

31
Q

How does poisoning caused altered LOA?

A

alters chemical environment (depends on type of ingestion)

creates acid base balance issues

32
Q

How do psychiatric illnesses cause altered LOA?

A

chemical imbalances cause alterations in neuron function leading to altered LOA

33
Q

What categories fall under S of AEIOU TIPS?

A

Stroke

Seizure

Syncope

34
Q

How does stroke cause altered LOA?

A

occlusion or hemorrhage affecting cerebral blood flow or drop in BP if hemorrhagic

35
Q

How do seizures cause altered LOA?

A

due to misfiring/excessive firing of neurons

36
Q

What is the mechanism behind syncopes causing altered LOA?

A

due to temporary drop in the amount of blood that flows to the brain

37
Q

When you are suspecting infection based on your assessment (sepsis, UTI, etc.), what is important to ask and gather more information on?

A
  • urinary habits over the last few days/week (frequency changes?)
  • pain?
  • discolouration?
  • odour?
  • Does the patient have a cathter? Check colour and output in the bag
  • history of antibiotic use
  • immunocompromised?
  • lesions/bed sores/wounds?
38
Q

What are the SIRS criteria?

A
  • temp ≥ 38.5° or <36°C
  • HR ≥90 bpm
  • RR ≥20 breaths/min
  • PaCO2 < 32 torr (<4.3 kPa)
  • WBC ≥12000 cells/mm3, <4000 cells/mm3 or ≥10% immature (bands) forms
39
Q

Describe the CTAS levels for temperature modifier

A

Immunocompromised - CTAS 2: neutropenia (or suspected), chemotherapy or immunosuppressive drugs including steroids

Looks Septic - CTAS 2: patient has evidence of infection, have 3 SIRS criteria positive, or show evidence of hemodynamic compromise, moderate respiratory distress or altered level of consciousness

Looks unwell - CTAS 3: patient has <3 SIRS criteria positive but appear ill- looking (i.e. flushed, lethargic, anxious or agitated)

Looks well - CTAS 4- patient has fever as their only positive SIRS criteria and appear to be comfortable and in no distress

40
Q

As per the Fever Standard in the BLS PCS, in situations involving a patient with a fever (known fever >38.5C or chief complaint of fever), the paramedic shall:

A

1. consider potential life/limb/function threats: OD, sepsis, meningitis, heat-related illness

2. Perform a secondary survery to assess:

    1. lungs, for adventitious sounds through auscultation
    1. skin, for: jaundice, rash, and signs of dehydration
    1. head/neck, for: photophobia, scleral jaundice, stiff neck, and headache
    1. abdomen, as per Abdominal Pain (Non-traumatic) Standard
    1. temperature

3. remove excess layers of clothing if required to promote passive cooling;

4. not actively cool the patient

5. prepare for potential problems, including seizures, if the patient is a febrile child or an adult in whom serious disorders (i.e. meningitis) are suspected

41
Q

As per Fever Standard in the BLS, consideration of sepsis is typically evidence by all of the following:

A
  • presence of fever: >38.5C
  • possible infection suspected (eg. pneumonia, UTI, abdo pain or distension, meningitis, cellulitis, septic arthritis, infected wound)
  • presence of any one of:
    • SBP <90
    • RR ≥22 breaths/min, or intubated for respiratory support
    • acute confusion or reduced LOC
42
Q

Pre-hospital ax & treatment for sepsis/infection

A

Assessment:

  • Physical ax: lungs, skin (C/C/T), head/neck, abdomen (See other card for more details); also checking for infectious wounds
  • Diagnostics:
    • Vitals: temp, BP. HR, RR, BGL, LOA, etc. & cardiac monitor

Treatment:

  • passive cooling (BLS)
  • pain management (ALS)
  • transported semi-sitting or most comfortable position
43
Q

When considering electrolytes/thermal exposure leading to altered LOA, what information would you like to gather?

A
  • Cause of the event - medication induced? trauma? environmental?
  • Length of exposure (temperatures)
  • medication or material ingested, and how much?
  • food/water intake (potential for dehydration?)
44
Q

As per the Heat-Related Illness Standard in the BLS PCS, in situations involving a patient experiencing a heat-related illness, the paramedic shall:

A

1. consider life/limb/function threats, such as: heat stroke & hypovolemic shock

2. perform a secondary survey to assess:

    1. CNS
    1. mouth, for state of hydration
    1. skin, for C/C/T & state of hydration
    1. extremities, for CSM
    1. temperature

3. move patient to a cooler environment

4. remove heavy or excess layers of clothing

5. if available at scene or from bystanders, provide water or electrolyte-containing fluids in small quantities if the patient is conscious, cooperative, able to understand directions and is not N/V

6. if working ax indicates heat exhaustion: move patient to ambo, remove as much clothing as possible

7. if working ax indicates heat stroke: provide same care^ & withold fluids, cover patient in wet sheets, and apply cold packs to axillae, groin, neck, head

45
Q

As per the Heat-related Illness Standard in the BLS PCS, what are the 4 specific chief complaints that fall under this standard?

A

1) Heat syncope

2) Heat cramps: severe cramping of large muscle groups

3) Heat exhaustion:

  • mild alterations in mental status, & non-specific complaints (headache, giddiness, N/V, malaise), with excessive sweating in healthy adults; or hot dry skin in elderly

4) Heat stroke:

  • severely altered mental status, coma, seizures, hyperthermia ≥40°C
  • Overdose of tricyclic anti-depressants, antihistamines and β-blockers, as well as cocaine, Ecstasy or amphetamine abuse may also lead to heat stroke
46
Q

Pre hospital ax and treatment for suspected electrolytes/thermal exposure

A

Assessment:

  • Physical ax: CNS, skin (turgor & C/C/T), oral mucosa, extremities
  • Diagnostics: classic vitals but especially temp & BGL; also 12-lead because potential for arrhythmias)

Treatment:

  • cold packs - neck, axillae, groin, head
  • fluids (H2O & electrolytes) - if conscious, able to follow commands, and no N/V
  • cool environment (ambulance, removing clothes)
  • other Sx relief as needed (ALS)
47
Q

When considering arrhythmias/oxygen leading to altered LOA, what ax and information would you like to gather?

A
  • relating to the event - what was the cause (meds, trauma, chronic illness???)
  • OD? How much and what?
  • How long has illness been getting worse (i.e. COPD exacerbations)
  • SpO2 levels normally? oxygen flow (liters at home) & potential changes recently
  • Recent dx of cardiac/respiratory
  • What is the rhythm? prepare pads is suspecting prearrest
  • Smoker?
48
Q

Pre-hospital Ax and Treatment of suspected arrhythmaia and/or oxygen related emergencies.

A

Assessment:

  • physical:
    • skin (C/C/T)
    • head (nasal flaring especially in peds, excessive drooling); cyanosis
    • neck (JVD, trach deviation)
    • chest (accessory muscle use, indrawings, auscultation)
    • extremities - cyanosis, edema
  • Diagnostics: all your vitals & 12-lead
  • Hx taking - meds like beta blockers!

Treatment: oxygen

  • naloxone (if OD)
  • semi-sitting or sitting position
  • ventilations if necessary
49
Q

When considering stroke leading to altered LOA, what ax and information would you like to gather?

A
  • Onset? LSN
  • Previous strokes/TIAs? - so Hx gathering
  • Deficits from previous strokes?
  • Meds?
  • neuro exam
50
Q

As per the Cerebrovascular Accident (CVA) Standard, the paramedic shall:

A
  1. consider other potentially serious conditions that may mimic a stroke, such as,
    1. drug ingestion (eg. cocaine)
    2. hypoglycemia
    3. severe HTN, hypertensive emergency, or
    4. CNS infection (eg. meningitis)
  2. ​ perform, at a minimum, a secondary survey to assess,
    1. ​head/neck for:
      1. ​facial symmetry,
      2. pupillary size, equality, and reactivity,
      3. abnormal speech
      4. present of stiff neck,
    2. CNS for,
      1. ​abnormal motor function (eg. hand grip strength, arm/leg movement/drift, and
      2. sensory loss, and
    3. for incontinence of urine/stool;
  3. ​ensure adequate support for the patient’s body/limbs during patient movement and place extra padding and support beneath affected limbs;
  4. prepare for potential problems, including,
    1. ​possible airway obstruction (if loss of tongue control, gag reflex),
    2. decreasing LOC,
    3. seizures, and
    4. agitation, confusion, or combativeness
  5. ventilate the patient if patient is apneic or respirations are inadequate,
    1. ​if ETCO2 monitoring is available,
      1. ​attempt to maintain ETCO2 values of 35-45 mmHg,
      2. notwithstanding paragraph 5(a)(i) above, if signs of cerebral hernation are present after measures to address hypoxemia and hypotension, hyperventilation patient to attempt to maintain ETCO2 values of 30-35mmHg. Signs of cerebral hernation include a deterioraring GCS <9 with any of the following: note that CVA can present the same as cerebral herniation due to increased ICP from blood/edema
        1. ​dilated and unreative pupils,
        2. asymmetric pupillary response, or
        3. a motor response that shows either unialteral or bilateral decorticate or decerebrate posturing, or
    2. if ETCO2 monitoring is unavailable, and measures to address hypoxemia and hypotension have been taken, and the patient shows signs of cerebral herniation (as per 5(a)(ii)) above, hyperventilate the patient as follows:
      1. ​Adult: approx 20 breaths per minute
      2. Child: approx 25 breaths per minute
      3. Infant < 1 year old: approx 30 breaths per minute
51
Q

As per the CVA Standard, what is the Acute Stroke Bypass Protocol?

A
  1. Assess patient to determine if he/she has one or more of the symptoms consistent with the onset of an acute stroke, as follows:
    1. inappropriate words or mute,
    2. slurred speech
    3. unilateral arm weakness or drift
    4. unilateral facial droop, or
    5. unilateral leg weakness or drift;
  2. if the patient meets criteria listed above, determine if patient can be transported to a Designated Stroke Centre* within 6 hours of a clearly determined time of symptom onset or time the patient was last seen in his/her usual state of health;
  3. if the patient meets criteria listed in (1) and (2) above, assess the patient to determine if he/she has any of the following contraindications:
    1. CTAS 1 and/or an uncorrected airway, breathing or circulation issue (GO TO CLOSEST FACILITY)
    2. stroke symptoms resolved prior to paramedic arrival or assessment (or improving)
    3. BGL <3 mmol/L (however if symptoms persist after correction of BGL, patient is not contraindicated)
    4. seizure at onset of symptoms or that is observed by the paramedic
    5. GCS <10
    6. Terminally ill or is in palliative care
    7. Duration of transport to the Designated Stroke Centre will exceed two hours;
  4. if patient does not meet any of the contraindications listed in paragraph 3 above, perform a secondary screen for a Large Vessel Occlusion (LVO) stroke using Los Angeles Motor Scale (LAMS);
  5. inform the CACC/ACS of the LAMS score to assist in determination of the closest or most appropriate*** Designated Stroke Centre; and
  6. if transport has been initiated to a Designated Stroke Centre and the patient’s symptoms improve significantly or resolve during transport, continue transport to the Designated Stroke Centre
52
Q

Los Angeles Motor Scale - LAMS

What is it and what three things are you assessing?

A

identfies if there is potential of a large vessel occlusion (in which cause you need EVT)

1) Facial droop - smile, show teeth, raise eyebrows and squeeze eyes shut

2) Arm drift: elevate with palm down, 45 deg if lying, 90 deg if sitting, 10 second count

3) Grip strength: have patient try to grasp examiner’s fingers

53
Q

LAMS scale: Facial droop

A

0 - Absent (No facial asymmetry aka normal)

  • Facial palsy 0-1 (NIHSS score)

1- Present (Partial or complete lower facial droop)

  • Facial palsy 2-3 (NIHSS score)
54
Q

LAMS scale - Arm Drift

A

0- Absent (No drift, normal)

  • Motor arm 0 (normal) - NIHSS

1 - Drifts down (Drifts down but does not hit the bed within 10 sec)

  • Motor Arm 1 (drift) - NIHSS

2 - Falls rapidly (Arm cannot be held up against gravity and falls to bed within 10 sec)

  • Motor Arm 2-4 (NIHSS)
55
Q

LAMS Scale - Grip Strength

A

0- Normal (no NIHSS)

1- Weak grip (weak but some movement)

  • NIHSS: grip strength weak (4), some movement against gravity (3), or some movement but not against gravity (2)

2- No grip (no movement; muscle contraction be seen but without movement)

  • NIHSS: muscle contraction but no movement (1) or no muscle contraction (0)
56
Q

LAMS of what score is highly predicted of large artery occlusion?

A

≥4 (max score is 5)

57
Q

When suspecting drug/alcohol overdose, withdrawal or poisoning, what ax and information would you like to gather?

A
  • What is their drug/alcohol of choice?
  • What was ingested and how much?
  • How long ago did they use, or how long have they been unconscious?
  • How many ODs?
  • Are they on methadone?
  • Any other drugs?
  • Route of administration
  • Bowel movements?
  • LOA/LOC?
  • Tx prior to arrival (i.e. naloxone)?
  • Are the drugs from a reliable source?
58
Q

If patient has had a syncopal or seizure episode, what ax and information are you gathering from these patients?

A
  • how long did the seizure/syncope last?
  • Onset - what were you doing when it started?
  • Witnessed/unwitnessed?
  • Full body involvement?
  • Underlying cause - trauma, hypoglycemia, epilepsy, infection withdrawal, tumor
  • Is pt managed with meds/have they been taking it as prescribed?
  • For withdrawal seizures: when was their last drink of alcohol?
  • Seizure hx and patterns: usually just one or back to back seizures?
59
Q

When suspecting a diabetic emergency, what information would be pertinent to obtain?

A
  • Are they insulin-dependent or managed with oral medication?
  • How long have the symptoms been going on?
  • Excessive thirst?
  • Increased urine output?
  • Note: patients act differently with low sugars, some may be very aggressive

OCHT Term III (25 decks)

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