Primary Complaints

Question 1

Causes of Coma/AMS

Answer 1

TIPS & AEIOU

T - trauma, temp
I - infection (systemic or CNS)
P - psychiatric
S - space-occupying lesion, stroke, subarachnoid hemorrhage, shock

A - alcohols/drugs
E - epilepsy, electrolytes, encephalopathy
I - insulin (DM)
O - oxygen deficit, opiates
U - uremia

Question 2

Cushing’s Reflex

Answer 2

sign of increased ICP

increased BP, decreased pulse

Question 3

Want LP?

Answer 3

Subarachnoid hemorrhage - immediate CT; if negative LP.

Intracranial abscess - immediate CT; if negative LP. Abx if delay for CT.

Meningitis (non-focal team; no suspicion for increased ICP) - immediate LP prior to CT; if delay for CT, give abx.

S/s increased ICP –> CT first (if delay, start abx if infection suspected).

Question 4

Treatment of AMS/Coma

Answer 4

ABCDEs
Check rapid glucose; give D50W.
Give 2 mg IV naloxone immediately if opioid OD suspected.
Consider abx if febrile.
Immediately intubate/ventilate any pt if increased ICP is suspected!!!
Consider mannitol 0.5-1 gm/kg IV.

Question 5

Fever (Child v. Adult) v. Hyperthermia

Answer 5

Fever, Child = 100.4F, 38C
Fever, Adult = 100.9F, 38.3C
Hyperthermia = 106.7F, 41.5C

Question 6

PCN Fever

Answer 6

7-10 days after starting PCN

Question 7

Fever in Sepsis

Answer 7

> 38/100.4 or < 36/96.8

Question 8

Fever Unknown Origin

Answer 8

> 38.3C/100.9F several time for > 3 weeks with uncertain ddx after 1 week in hospital –> usually occult infx (TB) v. malignancy