E3: AMS And Tox Flashcards
If a patient is awake and fully aware of their surroundings and responds appropriately to normal stimuli, what is their Level of consciousness?
Alert (this does not imply capacity to focus attention)
If a patient is not full alert and drifts off to sleep when not stimulated, their spontaneous movements are decreases, awareness if limited, and they are unable to pay attention and lose their train of thought constantly, what is their level of consciousness?
Lethargic or somnolent
A patient is difficult to arouse and when they are aroused, they are are confused. They require constant stimulation to elicit minimal cooperation. What is their level of consciousness?
Obtunded
Patient does not rouse spontaneously and requires persistent and vigorous stimulation for very little response. When they are aroused, they will moan or mumble. What is their level of consciousness?
Stuporous or semicomatose
What is the Glasgow Coma scale?
Grades coma severity according to eye opening, motor, and verbal responses
What is decorticate posturing and what does it indicate?
- Flexion with adduction of arms and extension of the legs (flexor response)
- Reflects destructive lesion in corticospinal tract from cortex to upper midbrain
What is decerebrate posturing and what does it indicate?
- Extension, adduction, and internal rotation of the arms and extension of the legs (extensor posturing)
- Associated with damage to the corticospinal tract at level of brainstem (pons or upper medulla)
Is decorticate or decerebrate posturing worse?
Decerebrate
What is major neurocognitive disorder (aka dementia)?
Significant cognitive impairment in at least one of the following domains: learning and memory, language, executive function, complex attention, perceptual motor function, and social cognition
What is delirium?
- Disturbance inattention and awareness
- the disturbance develops over a short period of time and represents a change from baseline and tends to fluctuate during the course of the day
Focal or lateralized neurologic findings (are/are not) characteristic of delirium.
Are not
What are the risk factors for delirium?
- Underlying brain disease
- Age >80
- Infection
- polypharmacy
- ETOH
- Men >women
- Multiple medical problems
- fractures
What does the Mnemonic MOVESTUPID stand for?
-mnemonic for common causes of AMS
Metabolic Oxygen Vascular Endocrine Seizure Trauma Uremia Psychogenic Infection Drugs
What is the treatment of AMS?
- Identify the underlying cause and treat it
- thiamine, dextrose, and nalaxone should be considered because their is little to no harm in using these even if youre wrong
When should Benzos be used for AMS and when should they be avoided?
- Consider them in cases of sedative drugs or alcohol withdrawal or sympathomimetic or anticholinergics poisonings
- Avoid in undifferentiated AMS
Should cholinesterase inhibitors be used in delirium?
No, they are not effective in preventing or treating the symptoms and they often create undesirable side effects
What are the 4 procedures to enhance elimination of poisons?
- Forced diuresis
- Urine ion trapping
- hemodialysis
- and exchange transfusion
What are the benefits of using antidotes?
- Prevent absorption
- bind and neutralize poisons directly
- antagonize end organ effects
- inhibit conversion to more toxic metabolites
What is the antidote for Tylenol poisoning?
N acetylcyteine
What is the antidote for amitriptyline poisoning?
Sodium bicarb
What is the antidote for anticholinergic poisoning?
Physostigmine
What is the antidote for beta blocker poisoning?
Glucagon
What is the antidote for Benzo poisoning?
Flumazenil
What is the antidote for CCB poisoning?
Calcium
