Mental Status & Toxicology (Exam #3) Flashcards
What mental status finding involves NOT fully alert, drifts to sleep, loses train of thought?
Lethargy/Somnolent
What mental status finding involves needing persistent stimulation, confusion?
Obtunded
What mental status finding involves needing vigorous and persistent stimulation, moan/mumble?
Stuporous/Semicomatose
What mental status finding involves unarousable unresponsiveness?
Coma
What are the three components of GCS?
- Eye movement
- Motor response
- Verbal response
What posture involves flexor response?
Decorticate
What posture involves extensor posturing?
Decerebrate
Where is the lesion located for Decorticate posturing? Where is the lesion located for Decerebrate posturing? Which is WORSE?
- Decorticate: cortex/upper midbrain
- Decerebrate = WORSE: brainstem
If a lesion is located in the cortex/upper midbrain, what posturing may be seen?
Decorticate
If a lesion is located in the brainstem, what posturing may be seen?
Decerebrate
What four conditions can differentiate Delirium from Dementia?
- Short period of time
- Fluctuates
- Abnormal vital signs and PE
- GLOBAL neuro findings
What is the primary RF associated with Delirium? What are three examples?
Underlying brain disease (Dementia, PD, CVA)
What is the mnemonic associated with the etiologies of AMS, and what does each letter stand for?
This is trash, I apologize
AEIOU TIPS
- Alcohol
- Epilepsy, endocrine
- Infection
- O2, opioids
- Uremia
- Trauma, temp., toxins
- Insulin
- Psychosis
- Stroke, shock
What two PE findings may be indicative of AMS?
- Pupil size
- Skin temp.
What three meds can ALWAYS be started with AMS?
- Thiamine
- Dextrose
- Naloxone
What two drug classes should be avoided with AMS? What else should be avoided/used as last resort?
Avoid restraints = last resort
- Benzos
- AChE-I
What drug can be considered ONLY if the AMS is severe and the patient is a harm to others?
Psychotropic drugs (Haldol)
What two developments are seen with physiologic EXCITATION?
- CNS stimulation
- Increase in BP, HR, RR, temp.
What four drug classes are responsible for physiologic EXCITATION?
- Anticholinergics
- Sympathomimetics
- Hallucinogens
- Drug withdrawal
What two developments are seen with physiologic DEPRESSION?
- Depressed mental status
- Decrease in BP, HR, RR, temp.
What five drug classes are responsible for physiologic DEPRESSION?
- Ethanol, methanol, ethylene glycol
- Sedative-Hypnotics
- Opioids
- Cholinergics
- Sympatholytics
Do Anticholinergics cause physiologic excitation or depression?
Physiologic EXCITATION
Do Sympathomimetics cause physiologic excitation or depression?
Physiologic EXCITATION
Do Hallucinogens cause physiologic excitation or depression?
Physiologic EXCITATION
Does drug withdrawal cause physiologic excitation or depression?
Physiologic EXCITATION
Does ethanol cause physiologic excitation or depression?
Physiologic DEPRESSION
Does methanol cause physiologic excitation or depression?
Physiologic DEPRESSION
Does ethylene glycol cause physiologic excitation or depression?
Physiologic DEPRESSION
Do Cholinergics cause physiologic excitation or depression?
Physiologic DEPRESSION
Do Sedative-Hypnotics cause physiologic excitation or depression?
Physiologic DEPRESSION
Do Sympatholytics cause physiologic excitation or depression?
Physiologic DEPRESSION
Do Opioids cause physiologic excitation or depression?
Physiologic DEPRESSION
What four labs should ALWAYS be obtained for toxicology?
- Pregnancy test
- Glucose
- Acetaminophen levels
- Salicylate levels
Which toxidrome involves “SLUDGE and Killer B’s”, and what are the 3 B’s? What other sxs may be seen?
CHOLINERGICS
- Salivation, Lacrimation, Urination, Defecation, GI issues, Emesis
- Bradycardia, Braonchorrhea, Bronchospasms
- MIOSIS
What is the antidote for Cholinergics (2)?
- Atropine
- 2-PAM
What is the phrase of sxs/signs associated with Anticholinergics?
- Blind as a bat
- Mad as a hatter
- Red as a beet
- Dry as a bone
- Hot as a hare
What is the antidote for Sympathomimetics?
Benzos + supportive
Which toxidrome involves dry/flushed skin, dec. BS, tachycardia?
Anticholinergics
What is the antidote for Opioids?
Naloxone + supportive
Which toxidrome involves miosis, bradycardia, hypothermia, hypotension?
Opioids
What is the antidote for Anticholinergics?
Physostigmine
Which toxidrome involves “fight or flight”?
Sympathomimetics
What is the “antidote” for Sedative-Hypnotics (2)? What med can be considered, and what is its associated risk?
TIME + supportive
- Consider Flumazeril = can induce seizures
What is often the first sign associated with Anticholinergic toxicity?
Tachycardia
Which toxidrome involves diaphoresis and inc. BS?
Sympathomimetics
Which toxidrome involves variable pupils, NORMAL vital signs, bradypnea, hyperreflexia?
Sedative-Hypnotics
