Syncope, Vertigo and Altered Mental Status (AMS) Flashcards
what is the presentation of increased arousal
hypervigilant, agitated
what is the presentation of decreased arounsal
lethargic, stuporous, comatose
what is the presentation of decreased cognition
confusion, amnesia, hallucinations, detachment from reality
define hyper alter
increased arousal with increased sensitivity to surroundings
define confused
disoriented, bewildered, difficulty following commands
define delirous
disoriented, restless, hallucinating, may be delusional
acute onset - usually reversible
defne somnolent
sleepy, response to stimuli with incoherent mumbles
define lethargic
reduced level of alertness, decreased interest in surroundings
define obtunded
like lethargy but more so. slowed response to stimulation, sleeps more than normal, drowsy between sleep episodes
define stuprous
profoundly reduced alterness, requres continued novious stimuli for arousal
define comatose
state of deep, unarousable, unconsciousness
what is the presentation of dementia
slow onset, progressive, degenerative
what is the presentation of psychosis
sudden onset, need to rule out organic causes
what are the initial actions for AMS
look for reversible causes and address ASAP
Dextrose - POC glucose
Oxygen - pulse ox
Narcan - check pupils
Thiamine - ETOH?
what is one of the first tests that are run on patients who present with AMS
CT head
what is the vestibular system
complex arrangement of bones and cartilage in the ear, network of semicircular canals filled with fluid. fluid position changes with movement, sensor in ears sends info to brain to contribute to balance
what underlying conditions can cause problems with the vestibular system that lead to balance issues
medications
infections
inner ear problems - such as circulation
calcium debris in semicircular canals
central problems in brain, e.g. TBI
what is the diagnostic approach to virtigo and dizziness complaints
TiTrATE
Timing of symptoms
Triggers that provoke symptoms
And a
Targeted
Evaluation
what are the three main categories of vertigo
triggered episodic vertigo
spontaneous episodic vertigo
continuous vestibular vertigo
what is triggered episodic vertigo
brief episodes lasting seconds to hours, intermittent
triggered by head or body movement or position change
what is spontaneous episodic vertigo
last seconds to days - no triggers
what is continuous vestibular vertigo
lasting days to week - need to ask about hearing loss
what can trigger ‘triggered episodic vertigo’
BPPV (benign paroxysmal positional vertigo)
Orthostatic hypotension
what is BPPV
benign paroxysmal positional vertigo - displaced canaliths in semicircular canals
most commonly occurs between 50-70 yo, no known cause in older people
can occur with head trauma in younger people
usually <1minute
often with rolling over in bed, always with change in head position
what is orthostatic hypotension
change in vitals with change from supine to standing for one minute
SBP down 20mmHg, DBP down 10mmHg, HR up 30 bpm
what conditions cause spontaneous episodic vertigo
Meniere’s disease and vestibular migraine
what is Meniere’s disease
with low frequency hearing loss, often unilateral
associated with pain, pressure and/or fullness in affected ear
hearing usually improves between attacks but can become permanent
what is the treatment of Meniere’s disease
diuretics, sodium restriction are initial treatments
what is Dix Hallpike Maneuver used for
determining which type of triggered episodic vertigo a patient has based on the direction of their nystagmus
what is epley maneuvers used for
therapeutic of for BPPV
what is vestibular migraine
common, under-diagnosed, +/- headache
duration of vertigo from minutes to hours (can be longer)
motion sensitivity, and sensitive to visual motion (like movies)
may also have photophobia, phonophobia and visual aura
what is the treatment of vestibular migraine
migraine meds and anti-emetics
what is continuous vestibular vertigo
not positional, continues regardless of head motion
hearing is intact
affect ages 30-50, possible viral trigger
acute onset
what is psychosomatic and functional dizziness
can be manifestation of depression, anxiety or panic disorder
need to also consider that anxiety can result from vestibular disorders
persistent postural-perceptual dizziness (PPPD)
what is the treatment for psychosomatic and functional dizziness
SSRI, SBT, vestibular rehabilitation. avoid vestibular suppressants
what is pre-syncopal dizziness due to
brain hypo-perfusion (often due to low BP)
what is the pre-syncopal prodrome
poor hearing, feeling warm/cold, pallor, diaphoresis, abdominal pain, palpitations, hearing strange sounds, weakness, blurred vision, feeling “faint”
what is syncope
loss of consciousness and muscle strength
what are the most common causes of syncope
neurocardiogenic syncope
reflex syncope
vasovagal syncope
what is cardiogenic syncope
life threatening
most commmon cause is arrhythmia - also ichemia, valvular abnormalities
often occurs without a prodrome
what are the risk factors for cardiogenic syncope
FH of sudden cardiac death or MI (esp younger than 50yo)
cardiac disease
cardiac symptomatology
what are differential diagnoses for syncope
seizure
stroke
trauma/head injury
sleep disturbance
