[HYHO] HPS 1 Flashcards
What scale is used to describe general level of consciousness in patients with TBI or other head injury?
Glascow Coma Scale
What are the 3 parameters of the Glascow Coma Scale? What are the maximum scores for each?
Eye opening - 4
Best Verbal response - 5
Best Motor response - 6
How are the parameters for Glascow Coma Scale scored?
Individually
E.g. E2V3M4 = GCS 9
What are the GCS scores for mild, moderate, and severe brain injury?
>13 = Mild
9 to 12 = Moderate
<8 = Severe
How is GCS scored for intubated patients?
Scored with a “T” bc no verbal response (intubated)
Min - 2T
Max - 10T
Delirium or Dementia?
Richmond Agitation-Sedation Score
Delirium
What is the purpose of using the Richmond Agitation-Sedation Score?
Screen level of alertness in a mechanically ventilated patient
Used before CAM-ICU or bCAM in Delirium Triage Screen
Delirium or Dementia?
Confusion Assessment Method (CAM)
Delirium
What screening test allows non-psychiatrists to detect delirium in high risk environments?
Confusion Assessment Method (CAM)
What are the 4 features required for a positive CAM?
1 - Acute onset and fluctuating course
2 - Inattention
3 - Altered Level of Consciousness
4 - Disorganized thinking
Must have features 1 AND 2 + either 3 OR 4
What are the 3 steps to performing the Richmond Agitation-Sedation Scale?
- Observe pt. Are they alert and calm (score 0)? Agitated/combative (+)? Difficult to arouse (-)?
- If pt not alert, loudly state pt’s name and direct them to open eyes and look at speaker.
- If pt does not respond to voice, physically stimulate by shaking shoulder and rubbing sternum
How are the positive scores on the Richmond Agitation-Sedation Scale described?
+4 - overtly Combative or violent, immediate danger
+3 - very agitated, aggressive to staff
+2 - Agitated, frequent nonpurposeful movement
+1 - Restless, anxious
How are the negative scores of the Richmond Agitation-Sedation Scale described?
- 1: Drowsy, >10 sec awake with eye contact and response to voice
- 2: Light sedation, <10 sec awakens with eye contact to voice
- 3: Mod sedation, Any movement to voice (no eye contact)
- 4: Deep sedation, no response to voice but responds to physical stimulation
- 5: Unarousable, no response to any stimulation
Delirium Triage Screen vs bCAM
Which is more sensitive? Specific?
Sensitive - Delirium Triage Screen
Specific - bCAM
Dementia or Delirium?
Onset: Slow
Course: Progressive
Dementia
Dementia or Delirium?
Abnormal physical exam
Visual hallucinations
Delirium
Dementia or Delirium?
Disturbance in attention/cognition
Evidence of cause by medical condition, substance intoxication/withdrawal, medication side effect
Delirium
Avoid ______ to treat delirium, except in alcohol withdrawal
Benzodiazepines!!!!
What is the strongest risk factor for dementia?
Advanced age
Review: Most common cause of dementia?
ALZHEIMER’S DZ
never forget
In general for dementia, decline in ______ precedes decline in ______
In general for dementia, decline in cognition precedes decline in function
When diagnosing dementia, you must first rule out _____
When diagnosing dementia, you must first rule out depression
What are the two classes of drugs used to treat dementia?
NMDA receptor antagonist - memantine
Cholinesterase inhibitors - donepezil, rivastigmine, galantamine
What kind of dementia is characterized by progressive course, prominent memory loss, symmetric neurological exam?
Alzheimer’s dementia
What kind of dementia is characterized by asymmetric neurological exam, risk factors/hx of stroke?
Vascular dementia
What kind of dementia is characterized by 2/3 of the following: parkinsonism, fluctuating cognition, well-formed visual hallucinations?
Lewy body dementia
What is the criterion for Parkinson’s disease with dementia?
Parkinson’s dz diagnosis precedes dementia by at least 1 year
What is the “I WATCH DEATH” mnemonic used for?
Differentia dx of delirium
What does “I WATCH DEATH” stand for?
I____
W____
A____
T____
C___
H___
D___
E___
A___
T___
H___
I-nfection
W-ithdrawal
A-cute metabolic
T-rauma
C-NS pathology
H-ypoxia
D-eficiencies
E-ndocrinopathies
A-cute vascular
T-oxins or drugs
H-eavy metals
Dementia scoring: Mini-cog
Components (2)
1 - 3 item recall test
2 - clock drawing test
Higher sensitivity for detecting MCI than MMSE, less affected by age and education levels, short (3 min)
Dementia scoring: Montreal Cognitive Assessment (MoCA)
Score range? Normal?
Score range 0-30, normal >25
- Better at detecting MCI than MMSE*
- Age 55-85 (idk why this one is specifically this number bc they all say for “older people” or “the elderly” so…)*
Dementia scoring: MMSE
Not uncommon for someone with AD to have scores decrease _____ points per year
Decrease 2-4 points per year
Score range same as MoCA (0-30, normal >25)
Widely used
Dementia scoring: SLUMS
What is the normal scoring for SLUMS?
Score 0-30
Normal:
25+ if less than high school education
27+ if high school education
Equivalent to MoCA for detecting MCI
What is Battle’s sign?
Bruising over the mastoid process caused by extravasation of blood along the posterior auricular A.
Sign of head trauma
What is hemotympanum?
Preesence of blood in the tympanic cavity of the ear, often as a result of basilar skull fx
5-Model Approach to AMS - Biomechanical
OMT modalities
FPR, BLT, ST, MET, consider HVLA
5-Model Approach - Neurological
OMT modalities
S/CS
Paraspinal inhibition
5-Model Approach - OMT Modalities
Respiratory/Circulatory
Rib raising, lymphatics, ST to C and T spine
5-Model Approach - OMT modalities
Metabolic, Energetic, Immune
Lymphatics, mesenteric release, FPR, BLT, ST, MET
5-Model Approach - OMT modalities
Behavioral
ST techniques for anxiety/depression
