EMED Block 2 Flashcards
GCS for comatose, need for intubation and normal?
Define AMS
3- comatose
8 or less- intubate
15- normal
Umbrella term for delirium, dementia and coma or any change in mental status
Elderly PT w/ AMS is usually due to one of what 4 things?
What are the 5 contents of consciousness
Pneumonia/sepsis
UTI
Skin infection
Stroke
Reasoning Language Emotions Self-awareness Spatial relationship integration
Define Delirium
Define Dementia
Define Coma
D/o of consciousness affecting arousal, wakefulness or basic alerting- flickering light, who’s home?
Failure of content portion of consciousness w/ preserved alertness- lights on, nobody home
Failure of both arousal and content functions- lights off, nobody home
AMS Slide 8
Table
Define Mental Status
How is this usually tested?
Clinical state of emotional/intellectual function
Informal- person place time/season, current event
? is a transient d/o w/ impaired attention/cognition*
How will PTs present
Delirium
Difficulty focusing, shifting or sustaining attention
Confusion may fluctuate
How long does it take for delirium to develop?
What are the clinical features of this?
Hrs to days
Inc daytime somnolence
Agitation/sun-downing
HTN Asterixis Tremor Sweating
If delirium PT has hallucinations they are usually ? type
How is delirium D
Visual
Hx and PE
Primarily- Hx from caregiver, family, spouse
How can you tell the difference between depression and delirium?
What two Dxs have to be r/o when working up suspected delirium case
Delirium= rapid fluctuation Depression= absent fluctuation, oriented, able to perform commands
Non-convulsive status epilepticus
Complex partial status epilepticus
What are 5 classes of issues that can induce acquired delirium
How are PTs w/ delirium Tx
What step is taken if a certain Tx step is done?
Metabolic/thyroid Drugs Infection Neurologic Cariopulmonary
Haloperidol 5-10mg PO/IV/IM
Benzos 0.5-2mg PO/IV/IM
Co2 Capnography
When would delirium PTs NOT be admitted
What are the two largest categories of dementia
Hypoglycemic
Uroseptic
Readily reversible agents
Idiopathic- Alzheimers
Vascular- multiple infarcts
How does dementia onset?
How do PTs w/ dementia present
Slowly w/ insidious Sxs
Hallucinations
Repetitive behaviors
Delusion/Depression
What is the characteristic onset of dementia associated w/ Alzheimers?
What are the 3 stages of dementia?
Impaired memory/orientation w/ preservation of motor/speech disability
Early: memory loss of names/items
Mid: early + reading, dec social function, loss of direction
Late: extreme disorientation, no self care, personality changes
What are the PE findings of vascular dementia?
How would a PT w/ dementia and Parkinson’s present?
Exaggerated/asymmetric DTRs
Gait abnormalities
Extremity weakness
Inc motor tone
Rigidity/movement d/o
What labs are ordered to assess dementia?
Vascular dementia requires ? for Dx
CBC CMP Syphilis TFTs UA B12
CXR HIV ESR Folate
Signs of cerebrovascular Dz on CT
What is the relation between a stroke and cognitive decline of dementia
Trifecta of ? issues can present as a mild dementia but functioning PT
Dementia w/in 3mon of stroke or,
Abrupt deterioration in memory/cognitive abilities
CHF UTI Hypothyroid
Define Pseudo-Dementia
How is dementia Tx
Depression imitating dementia
Anti-psychotics for persistent psychotic features due to s/e
How is vascular dementia Tx
When is a Dx of Normal Pressure Hydrocephalus considered in dementia PTs
Dec HTN/cholesterol
Large ventricles on head
Early development of urinary incontinence/gait disturbances (wet and wobbly)
Glasgow Coma Scale, Motor
6 Follow 5 Localize 4 Withdraws 3 Flex 2 Extend 1 None
Glasgow Coma Scale, Verbal
5 Orientated 4 Confused 3 Inappropriate 2 Incomprehensible 1 None If PT is intubated, 'T' added in place
Glasgow Coma Scale, Eye Open
4 Spontaneous
3 To command
2 To pain
1 None
What labs are ordered to assess dementia?
Vascular dementia requires ? for Dx
CBC CMP Syphilis TFTs UA B12
CXR HIV ESR Folate
Signs of cerebrovascular Dz on CT
What is the relation between a stroke and cognitive decline of dementia
Trifecta of ? issues can present as a mild dementia but functioning PT
Dementia w/in 3mon of stroke or,
Abrupt deterioration in memory/cognitive abilities
CHF UTI Hypothyroid
Define Pseudo-Dementia
How is dementia Tx
Depression imitating dementia
Anti-psychotics for persistent psychotic features due to s/e