EMED 2 Flashcards
Define Mental Status
Define Delerium
Clinical state of emotional and intellectual function
Transient disorder of impaired attention and cognition w/ difficulty shifting/maintaining attention
Define Dementia
Define Coma
Failure of content portion of consciousness w/ preserved alerting functions
Failure of arousal and content functions
Define the pathophysiologies for delirium
Wide neuron/transmitter dysfunction due to:
Priary intracranial dz (bleed mass stroke)
Systemic dz (pyelonephritis UTI sepsis)
Exogenous toxin (drug poison)
Withdrawal (DTs opiates)
What are the two etiologies of dementia
What causes a stroke?
Idiopathic- Alzheimer’s
Vascular- cerebrovascular dz w/ multiple/repeat infarction
Deficiency of glucose/O2 supply
What are the different coma etiology categories?
Uncal: medial lobe pushes on brain stem/CN3= ipsilateral pupil dilation, hemiparesis
Central herniaion: cerebral edema of increased ICP causing LoC, loss of brain stem reflexes, decorticate posture, irregular RR
Inc ICP- >15mmHg decreases perfusion leading to ischemia
Define Kellie-Monroe doctrine
What is the equation
Increase of one fluid within the brain should cause reciprocal decrease of the other two pressures
CPP= MAP - ICP
How long does it take for delirium to develop?
How does it present
Hours to days
Altered thinking, memory and perception
Outbursts Hallucinations HTN Asterexis Tachy Sweat Somnolence/Sun downing
How long does it take for dementia to develop?
Define the characteristic Alzheimer’s onset
Slow and insidious onset of hallucinations, repetitive behavior, delusion/depression
Impaired memory/orientation w/ preserved speech/motor ability
What are the two categories of dementia?
How does each present
Idiopathic, forgetfulness of-
Early: items, names
Mid: direction reading social
Sev: personality self-care disorientation
Vascular:
Gait abnormality
Extremity weakness
DTRs exaggerated/asymmetric
What are the 3 causes of comas
Diffuse- toxic/metabolic
Small reactive pupils, no PE findings
Focal- structural coma
Supratentorial (uncle)- HTN, bradycardia, WPP
Infratentorial- abrupt coma, extensor posture, no pupil reflex/EOMs
Pseudo- faker won’t look at you
+nystagmus w/ caloric test
How is delirium Dx
What labs are ordered
What rads are ordered
Hx PE Medication consolidaiton
CBC LP UA E+ HR function
CXR Head CT
How is dementia Dx?
What labs are ordered?
What rads are ordered?
Hx PE
LCC STUB CHEF
CT MRI
How is GCS measured
How does opiate syndrome coma present
Motor: FLWFEN
Verbal: OCIIN
Eye: SCPN
Hypoventilation
Small pupils
How does cholinergic syndrome coma present?
Asymmetric PE findings in coma PTs means?
Extensor/flexor posturing indicates?
Miosis Lacrimation Seizure
Focal CNS lesion
CNS dysfunction
What is the imaging modality of choice for AMS?
How is delirium PTs managed?
Non-contrast CT
Tx underlying issue
Haldol/Benzo w/ capnography
B52- Benadryl, Ativan, Haldol
What is the disposition for delirium, dementia, coma?
What are the causes of delirium in elderly PTs
Reversible can be d/c
Admit all others
Pneumonia UTI Sepsis Skin infxn Metabolic/toxin Drugs Infection Neuro Cardiopulm
What are the DDx for coma
Alcohol Acidosis Arrhythmia Endocrine E+ Encephalopathy Infection O2 OD Opiates Uremia Trauma Temp Thiamine Insulin Poison Psych Stroke Seizure Space lesion Shunt malfunction
DDx for delirium
DDx for dementia
Non-convulsive/complex partial status epilepticus
Hypothyroid UTI CHF- mild but functional dementia
PT w/ seizure Hx hasn’t woken up after 30min since seizure stopped needs to have ? DDx considered
What is the 5th MC Sx seen in the ED?
Non-convulsive status epilepticus
HAs
Primary HAs include?
Secondary HAs include?
Migraine Cluster
Tumor Meningitis SAH
HA onset during exertion needs to have ? two Dxs considered
HA associated w/ valsalva indicates ? issue?
SAH
Arterial dissection of carotid or vertebrobasilar circulation
Intracranial abnormality
? PT population w/ new or worsening HA is high risk
Why is this risk present?
> 50y/o w/ new or worsening HAs
Migraine, cluster, and tension HAs decrease w/ age
PTs on what three classes of meds are at increase risk for hemorrhage and automatically get CT scan?
Anticoagulants
Antiplatelets
ABX
Define Reversible Cerebral Vasoconstriction Syndrome
Why does this occur
Coke/Meth/Amphetamine use increases risk for hemorrhage
Vasospasm and ischemia affects smooth muscles