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Q4 EM Surg > Exam 2 ALTERED MENTAL STATUS > Flashcards

Exam 2 ALTERED MENTAL STATUS Flashcards

1
Q

Levels of Consciousness? (5)

A 
Alert
Lethargic/Solemn
Obtunded
Stupor
Coma
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2
Q

Alertness includes?

Doesn’t include?

A

awake and aware,
N response to stimuli

Ability to focus attention

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3
Q

ABCD of initial eval?

A

Airway
Breathing
Circulation
Dextrose (get FSBS)

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4
Q

AVPU is?

A

Neuro test:

Alert, Verbal, Painful, Unresponsive

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5
Q

Initial intervention for coma includes? (3)

A

O2
IV access/Fluid resuscitation
Coma Cocktail:
Thiamine + D50W + Naloxone

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6
Q

Coma Cocktail response tells us?

A

If wakes w/i 2-3 min = hypogly or opiate OD

No response = keep looking

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7
Q

Labs for coma? (8)

A 
ABG
BAL
Blood CX
CBC
CMP
CSF
Drug screen
UA
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8
Q

Studies for coma? (3)

A

EKG
CXR
CT

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9
Q

Physical exam for coma includes? (8)

A

Vitals repeated often

Order of exam:
Skin (temp, text, tracks)
Neck (meningeal, JVD)
Chest (breath, heart, wall integrity)
Abd
Extrem (stable pelvis, movement)
Neuro (GCS, CNs, reflex, pupils, anal sphincter)
Psych
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10
Q

Breath odors tell us:

Fruity?

Bitter almond?

Rotten eggs?

Oil/Gas?

Fluor green, no odor?

A

Fruity = DKA, Nitrites, isoprop alcohol

Bitter almond = cyanide

Rotten eggs = hydrogen sulfide

Oil/Gas = hydrocarbons

Fluor green, no odor = ethylene glycol

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11
Q

Cholingergic Poisoning:

Caused by?

Sx onset?

Results in?

Tx?

A

Cause: organophos, nn gas, mushrooms

Onset: 8 hrs

Results: seizure, coma, resp/card fail

Tx: 2-PAM or Atrophine

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12
Q

Cholingergic Poisoning: Presentation?

A

DUMBELS

Defection
Urination
MM weakness
Bradycard, Bronchorrhea, Bronchospasm
Emesis
Lacrimation
Salivation
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13
Q

Anticholingergic Poisoning:

Caused by?

Tx?

A

Causes: TCA, Antipsych, Antihist, Jimson weed

Tx: monitor/support

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14
Q

Anticholingergic Poisoning: Presentation?

A 
Hot as a hare (fever)
Blind as a bat (mydriasis)
Dry as a bone (↓BS, urine retent, dry muc mem)
Red as a beet (flushing)
Mad as a hatter (toxic psychosis)
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15
Q

TCA Poisoning:

Presentation?

Tx?

A 
Pulmonary edema
Antichol sxs
AV block (Na/K chan block)
HypoTN
Confusion, Halluc, Seizure, Coma

EKG monitor
Activate charcoal
Sodium bicarb
BZs

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16
Q

Opioid Poisoning:

Presentation?

Tx?

A

CNS depr, miosis, resp depress

Vent support, Naloxone

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17
Q

Sympathomimetic Poisoning:

Caused by?

Presentation?

Tx?

A

Cocaine, Meth

Psychomotor agitation, mydriasis, diaphoresis, tachy, HTN, rhabdomyolysis, MI

Cooling, sedation, hydration

18
Q

Antidotes:

Acetaminophen?

Antichol?

BZs?

β-block?

CCB?

Digoxin?

Heavy metals?

Narcotics?

A

Acetaminophen = acetylcystine

Antichol = physostigmine

BZs = Flumazenil (Ramazicon)

β-block = glucagon

CCB = Ca2+

Digoxin = Digibind

Heavy metals = chelation

Narcotics = Naloxone

19
Q

Sedative-Hypnotic W/D caused by?

A

BZs and barbs

Result of abrupt stop after long use or high doses

20
Q

Sedative-Hypnotic W/D presentation?

A 
Agitiation
Tremor
N/V
Tachy
Hallucinations
Flushing
21
Q

Sedative-Hypnotic W/D tx?

A

Short-acting barb then long in equiv dose

Pentobarb 300mg PO or 200 mg IM until aroused ->

Phenobarb PO tapered over 10 days

22
Q

Seizures from W/D caused by?

A

U earliest sign of EtOH w/d (b/w 6-48 hrs)

May become DTs

23
Q

Seizures from EtOH W/D presentation?

A

U focal
U pt still responsive to verbals
Rare loss of bowel/bladder
No post-ictal state

24
Q

Seizures from EtOH W/D tx?

A

U self-limit
Close observation 24 hrs
If repeat seizure, single dose Phenobarb or Valium
*Dilantin doesn’t work

25
Q

e- Abnormalities that cause AMS?

Presentation?

A

U hypoNa+ < 120

Delirium, drowsiness, seizure, coma

26
Q

Metabolic causes of AMS? (4)

A

Endocrine
Hepatic
Renal
Thyroid storm

27
Q

Metabolic AMS presentation?

A

Mental status flux w/ lucid periods,
No focal abnormalities
Visual halluc
Recent memory not intact

28
Q

AMS Presentation resulting from Acute Psych Disorders? (4)

A

U recent memory retention intact
Able to perform simple calculations
Auditory halluc
U a/w drug/alcohol

29
Q

Thrombotic Thrombocytopenia Purpura presentation?

Tx?

A

Acute fever, bleed/rash, renal fail, neuro ∆s
C 20-40yo F
Related to vWF

plasma exchange + steroids

30
Q

Acute head trauma rectal exam tells us?

A

If tone intact = likely intracranial injury

If ↓ or no tone = coexisting spinal cord injury

31
Q

HYPOthermia is?

Presentation?

A

Skin temp ~ 91F

Periph vasoconst
Shivering
Mental status ∆
CV ∆
Resp ∆
Apathy, Lethargy, Ataxia
32
Q

HYPERthermia is:

Exhaustion?

A

Exhau: Core temp N to < 106
Ortho hypoTN, tachy, sweating

Stroke: Core temp > 106
Same + CNS dysf

33
Q

Typical Infection AMS causes in elderly?

Infants?

A

urosepsis, PNA

meningitis, sepsis

34
Q

Inflamm causes of AMS?

A

SLE
Giant cell arteritis
Sarcoidosis

35
Q

Acute intoxication presentation?

A 
Metabolic encephalopathy
Periph vasodil
Tachy
HypoTN
HYPOTHERMIA
36
Q

Acute intoxication stupor occurs at what BAL in non-chronics?

A

250-300 mg

37
Q

Wernicke’s is?

Presentation?

Tx?

A

EMERGENCY
Acute thiamine deficiency w/ carbohydrate ingestion from alcoholism, malnutrition or both

Ophthalmoplegia, nystag, ataxia, confusion,
Peripheral Neuropathy

38
Q

Wernicke’s tx?

A 
Thiamine IV (P) + Mg
Rest to protect CV
39
Q

DT’s are?

Presentation?

A

LIFE THREATENING
From EtOH w/d (3-4 days post)

Significant delirium w/ tremors, agitiation,
Purposeless activity,
Visual halluc,
Tachy,
Dilated pupils
Fever, Sweating
40
Q

DT tx? (4)

A

Thiamine IV/IM
Fluids
Vit C/B
Librium to prevent seizures

Q4 EM Surg (27 decks)

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