Emergency Medicine - Altered Mental Status Flashcards
Delirium Onset? Course? Vitals? Physical Exam? Hallucinations? Cause? Prognosis?
Fast. Fluctuates. Mostly Abnormal. Mostly Abormal. Visual (external stimuli). ORGANIC. Poor (if cause not treated).
Dementia Onset? Course? Vitals? Physical Exam? Hallucinations? Cause? Prognosis?
Slow. Progressive. Normal Usually Normal Rarely. Organic. Progressive worsening
Psychosis Onset? Course? Vitals? Physical Exam? Hallucinations? Cause? Prognosis?
Variable. Variable. Usually normal. Usually normal. Auditory (internal stimuli). Functional (Psychiatric) cause. Variable.
What does AVPU stand for when assessing mental status.
Alert/Voice/Pain/Unresponsive.
If a AMS patient has altered vitals or physical exam findings, what is their classification?
Delirium.
What does ABCDEF stand for when assessing patient?
Airway Breathing Circulation Disability Exposure Finger Stick Blood Glucose
Do you know the GCS score breakdown?
Good, cuz I was too lazy to make it again.
Most common cause of Delirium?
Drug effect.
Especially Narcotics and benzodiazepenes.
DDx for delirum (4)?
Drug Effect, MI, CNS process (stroke), Infectious process (UTI).
Drug therapy for agitated patients (if not psychotic)?
Benzodiazepines, such as Lorazepam (Ativan).
How to treat hypoglycemia in infants, toddlers, children, and adults?
Rule of 50 Infants: D5*10ml/kg Toddlers: D10*5ml/kg Children: D25*2ml/kg Adults: 1-2 Amps of D50
EAT SOMETHING!
Causes of AMS from hyperglycemia (4)?
DKA, HHNK, Sepsis, Medication effect (steroids).
Someone OD’s on an opiate. What do you give them? What is the target when administering?
Naloxone (Narcan). Restoration of respiratory drive, NOT AMS.
What is the biggest issue with giving naloxone?
It wears off (30-60 minute half life) before the drug does.
Do strokes typically induce AMS? Associated neurological deficits (3)?
No. Cortical blindness, aphasia, hemi-paralysis.
If a patient is getting violent in the room, what does his ass need to shut the fuck up and calm down so that he can answer your questions.
Ativan.
What does a patient with sympathomimetic toxidrome look like (including vitals) (5)?
Mental status complications? (4)
Most often caused by?
Most dangerous complication?
A tachycardic, high BP, sweaty person with goosebumps, and dilated pupils.
Delusional, paranoid, agitation, seizures.
Drug abuse.
Sudden Cardiac Arrest.
How to workup Sympathomimetic Toxidrome (4)?
BMP, EKG, Total CK, Urine Drug screen.
which drug should be avoided in the treatment of Sympathomimetic Toxidrome?
Beta blockers.
central vertigo - describe, causes
slow onset, not affected by movement, mild severity, CN abnormalities, nystagmus persists. causes: Brainstem ischemia, posterior fossa tumors, MS, drugs anticonvulsants, PCP, ethanol
peripheral vertigo - describe, causes?
rapid onset, recurs/abates every few hours, worse severity than central, no CN abn, nystagmus extinguishes. causes: acoustic schwannoma, meniere’ dz, inf (labyrinthitis), benign positional vertigo, trauma (endolymphatic fistula), labyrinthine concussion
vertigo + dysphasia/dysphonia/ataxia/diplopia/miosis/BL blurred vision
central vertigo
spinning sensation + hearing loss
peripheral vertigo due to acute labyrinthitis - typically after URIs, otitis media
middle aged with vertigo, hearing loss, tinnitus
classic triad of meniere’s dz. hearing loss typically persists bw episodes
dizziness with incr in sx with cough, sneeze or straining
trauma related vertigo
rotatory or horizontal nystagmus with vertigo
peripheral vertigo
vertigo + vertical or dysconjugate nystagmus
central vertigo
dizziness that disappears when hold onto something
dysequilibrium
Work up for seizure (4)?
Head CT, anti-epileptic drugs, stat EEG, check electrolytes.
Should an AMS patient ever not get a full ABCDE workup?
Fuck NO!
Should an AMS patient ever not get a thorough physical exam and vitals?
Fuck NO!
Delirium always has an _____ etiology?
Organic.
Important parts of the workup for Meningitis (2)?
LP/CT scan and empiric antibiotics.
Etiologies of delirium
AEIOU TIPS
alcohol, endocrinopathy/encephalopathy/electrolytes, insulin/inf/incr ICP, opiates/oxygen, uremia, trauma/toxins/tumor/T, inborn errors of metabolism, psychiatric, post-ictal (todd’s paralysis), seizure/stroke/shock/space-occupying lesions
Coma
Brain stem dysfunction or bilateral cortical disease
