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Surgery > Emergency Medicine - Altered Mental Status > Flashcards

Emergency Medicine - Altered Mental Status Flashcards

1
Q 
Delirium 
Onset?
Course?
Vitals?
Physical Exam?
Hallucinations?
Cause?
Prognosis?
A 
Fast.
Fluctuates.
Mostly Abnormal.
Mostly Abormal.
Visual (external stimuli).
ORGANIC.
Poor (if cause not treated).
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2
Q 
Dementia
Onset?
Course?
Vitals?
Physical Exam?
Hallucinations?
Cause?
Prognosis?
A 
Slow.
Progressive.
Normal
Usually Normal
Rarely.
Organic.
Progressive worsening
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3
Q 
Psychosis
Onset?
Course?
Vitals?
Physical Exam?
Hallucinations?
Cause?
Prognosis?
A 
Variable.
Variable.
Usually normal.
Usually normal.
Auditory (internal stimuli).
Functional (Psychiatric) cause.
Variable.
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4
Q

What does AVPU stand for when assessing mental status.

A

Alert/Voice/Pain/Unresponsive.

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5
Q

If a AMS patient has altered vitals or physical exam findings, what is their classification?

A

Delirium.

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6
Q

What does ABCDEF stand for when assessing patient?

A 
Airway
Breathing
Circulation
Disability
Exposure
Finger Stick Blood Glucose
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7
Q

Do you know the GCS score breakdown?

A

Good, cuz I was too lazy to make it again.

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8
Q

Most common cause of Delirium?

A

Drug effect.

Especially Narcotics and benzodiazepenes.

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9
Q

DDx for delirum (4)?

A

Drug Effect, MI, CNS process (stroke), Infectious process (UTI).

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10
Q

Drug therapy for agitated patients (if not psychotic)?

A

Benzodiazepines, such as Lorazepam (Ativan).

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11
Q

How to treat hypoglycemia in infants, toddlers, children, and adults?

A 
Rule of 50
Infants: D5*10ml/kg
Toddlers: D10*5ml/kg
Children: D25*2ml/kg
Adults: 1-2 Amps of D50

EAT SOMETHING!

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12
Q

Causes of AMS from hyperglycemia (4)?

A

DKA, HHNK, Sepsis, Medication effect (steroids).

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13
Q

Someone OD’s on an opiate. What do you give them? What is the target when administering?

A

Naloxone (Narcan). Restoration of respiratory drive, NOT AMS.

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14
Q

What is the biggest issue with giving naloxone?

A

It wears off (30-60 minute half life) before the drug does.

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15
Q

Do strokes typically induce AMS? Associated neurological deficits (3)?

A

No. Cortical blindness, aphasia, hemi-paralysis.

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16
Q

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.

A

Ativan.

17
Q

What does a patient with sympathomimetic toxidrome look like (including vitals) (5)?
Mental status complications? (4)
Most often caused by?
Most dangerous complication?

A

A tachycardic, high BP, sweaty person with goosebumps, and dilated pupils.
Delusional, paranoid, agitation, seizures.
Drug abuse.
Sudden Cardiac Arrest.

18
Q

How to workup Sympathomimetic Toxidrome (4)?

A

BMP, EKG, Total CK, Urine Drug screen.

19
Q

which drug should be avoided in the treatment of Sympathomimetic Toxidrome?

A

Beta blockers.

20
Q

central vertigo - describe, causes

A

slow onset, not affected by movement, mild severity, CN abnormalities, nystagmus persists. causes: Brainstem ischemia, posterior fossa tumors, MS, drugs anticonvulsants, PCP, ethanol

21
Q

peripheral vertigo - describe, causes?

A

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

22
Q

vertigo + dysphasia/dysphonia/ataxia/diplopia/miosis/BL blurred vision

A

central vertigo

23
Q

spinning sensation + hearing loss

A

peripheral vertigo due to acute labyrinthitis - typically after URIs, otitis media

24
Q

middle aged with vertigo, hearing loss, tinnitus

A

classic triad of meniere’s dz. hearing loss typically persists bw episodes

25
Q

dizziness with incr in sx with cough, sneeze or straining

A

trauma related vertigo

26
Q

rotatory or horizontal nystagmus with vertigo

A

peripheral vertigo

27
Q

vertigo + vertical or dysconjugate nystagmus

A

central vertigo

28
Q

dizziness that disappears when hold onto something

A

dysequilibrium

29
Q

Work up for seizure (4)?

A

Head CT, anti-epileptic drugs, stat EEG, check electrolytes.

30
Q

Should an AMS patient ever not get a full ABCDE workup?

A

Fuck NO!

31
Q

Should an AMS patient ever not get a thorough physical exam and vitals?

A

Fuck NO!

32
Q

Delirium always has an _____ etiology?

A

Organic.

33
Q

Important parts of the workup for Meningitis (2)?

A

LP/CT scan and empiric antibiotics.

34
Q

Etiologies of delirium

A

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

35
Q

Coma

A

Brain stem dysfunction or bilateral cortical disease

Surgery (34 decks)

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