disorders of consciousness

Question 1

5 big reasons for alteration of LOC

Answer 1

DSEMI
Delirium
Subdural hematoma
Epidural hematoma
Meningitis
Intoxications

Question 2

Number one cause of delirium?

Answer 2

infection: pneumonia and uri and sepsis

Question 3

pathophysiology of delirium, structures affected?

Answer 3

cerebral cortex, basal ganglia, thalamus

Question 4

Well known drug causes of Delirium?

Answer 4

ACH deficiency (mediates arousal in reticular formation). Anticholinergics: TCA, anti-emtics, anti-HTN.

Question 5

Common causes of delirium

Answer 5

Infection, metabolic, eletrolyte, meds, dehydration, MI, Stoke, etoh, illicits, organ failure, recent surgery, anesthesia.

Question 6

Neuro exam in delirium

Answer 6

MMSE, strength, sensory, CN, visual, nuchal rigidity

Question 7

Labs in delirium

Answer 7

CXR ALWAYS, UA ALWAYS, blood cx, CBC, CMP, Renal, Liver, toxicology, cardiac enzymes, abgs, EKG, CT/MRI ,LP, EEG

Question 8

most common org in bac menigitis

Answer 8

s. pneumoniae and n. meningitidis

Question 9

7 features of bac meningitis

Answer 9

rapid developing fever
nuchal rigidity
HA
alt mental status
seizures
photophobia
meningococcemia (skin rash)

Question 10

concern for bac menigitis. What to do?

Answer 10

Blood cx, STAT IV abx ceftriazone and vancomycin (add ampicilin if over 65 for listeria) and THEN LP. Also IV dexamethasone. CT, CMP, Heme 8, Coags, other tests to RO

Question 11

LP findings for bac meningitis infection?

Sensitivity?

Answer 11

high protein low glucose
> 5 WBC/mmm or > 1 PMN or > 1 eosinphil
80% sensitivity

Question 12

lucid interval followed by Loss of consciousness?

Answer 12

Epidural hematoma (ballon or LENS shape)

Question 13

Cresent shape bleed?

Answer 13

Subdural hematoma

Question 14

drug to prevent etoh withdrawl

Answer 14

aggressive doses of benzodiazepines and chronic alcoholics with Thiamine to prevent Wenicke’s encephalopathy.