USAFP
Adult Emergencies: Acute Mental Status ChangeInstructor VersionObjectives:Recognized acute mental status changes in a simulated patient Gathered from patient and family pertinent history Performed appropriate physical exam, include a quick MMSEListed a reasonable differential diagnosisOrdered appropriate labs and rads to begin emergent work up of a patient with acute MS changes.Different Types of Altered Mental Status:Confusion: Unable to maintain coherent thought processDelirium: Waxing, waning confusional state w/additional signsDrowsiness: Decreased level of consciousness, rapid arousal to verbal, noxious stimuliStupor: Impaired arousal, some purposeful movementsComa: Sleep-like state, unresponsive, no purposeful movementsEtiologies:Primary NeurologicSystemicStrokeCardiac: CHF, HTN encephalopathySeizurePulm: PaO2, PaCO2InfectionGI: Liver failure, Wilson’sEpidural or subdural hematomaRenal: Uremia, hypo/hypernatremiaConcussion, TBIEndocrine: glc, DKA, HHNS, Ca,Hypo/hyperthyroidism, Addisonian crisisHydrocephalusID: PNA, UTI, sepsisComplicated migraineHypo/HyperthermiaVenous thrombosisMedications (opiates, sedatives)CNS vasculitisAlcohol, ToxinsCholesterol or fat emboliInitial Evaluation: Hx: Previous or recent illnesses, including underlying dementia, psychiatric d/o, head trauma, alcohol and/or drug usePE: Evaluate for trauma, stigmata of liver dz, embolic phenomena, signs of drug use, nuchal rigidity, subarachnoid hemorrhageNEURO EXAM:Observe for spontaneous movements, response to stimuli, mini-mental examCranial nerves: eye position at rest, response to visual threat, corneal reflex, facial grimacePupil size and reactivity: pinpoint, midposition & fixed, fixed & dilated, Intact oculocehpalic: Doll’s eyes or oculovestibular (calorics)Signs of ICPMotor Response: posturing vs. purposeful movementsDTRsTreatment:Control airway, monitor VSs, IV accessC-spine precautions, increase HOB if ICP or herniation suspected, hyperventilation, dexamethasone, neurosurgical consultGive thiamine (before dextrose in case of Wernicke’s), dextrose, naloxone, flumazenilDiagnostic Studies:Head CT, MRICXR, C-spineCBC, ESR, electrolytes, BUN, Cr, ABG, LFTs, coags, tox screen, TSH, VDRL, B12, folate, UA, UDSLumbar punctureEKG, EEGGlasgow Coma ScoreEye OpeningBest Verbal ResponseBest Motor ResponsePointsFollows commands6OrientedLocalizes pain5SpontaneousConfusedWithdraws from pain4To VoiceInappropriate wordsFlexor response3To Painful stimuliUnintelligible wordsExtensor response2NoneNoneNone1Causes of Metabolic AcidosisM: MethanolU: UremiaD: DKAP: ParaldehydeI: InfecitonL: Lactic AcidosisE: Ethylene gylcolS: SalicylatesAEIOUM&MTIPSA: Alcohol E: Epilespy (esp post-ictal)I: InsulinO: Overdose, oxygenation (lack of)U: Uremia, underdoseM: Myocardial&: AnesthesiaM: MetabolicT: Trauma, fractureI: InfectionP: Psych, poisoningS: Stroke, shockAdult Emergencies: Altered Mental StatusObjectives:Recognized acute mental status changes in a simulated patient Gathered from patient and family pertinent history Performed appropriate physical exam, include a quick MMSEListed a reasonable differential diagnosisOrdered appropriate labs and rads to begin emergent work up of a patient with acute MS changes.Different Types of Altered Mental Status:Confusion:Delirium:Drowsiness: Stupor: Coma: Etiologies:Primary NeurologicSystemicStrokeCardiac: SeizurePulm:InfectionGI: Epidural or subdural hematomaRenal: Concussion, TBIEndocrine: HydrocephalusID: Complicated migraineHypo/HyperthermiaVenous thrombosisMedications (opiates, sedatives)CNS vasculitisAlcohol, ToxinsCholesterol or fat emboliInitial Evaluation: Hx: Previous or recent illnesses, including underlying dementia, psychiatric d/o, head trauma, alcohol and/or drug usePE: Evaluate for trauma, stigmata of liver dz, embolic phenomena, signs of drug use, nuchal rigidity, subarachnoid hemorrhageNEURO EXAM:Observe for spontaneous movements, response to stimuli, mini-mental examCranial nerves: eye position at rest, response to visual threat, corneal reflex, facial grimacePupil size and reactivity: pinpoint, midposition & fixed, fixed & dilated, Intact oculocehpalic (‘doll’s eyes’) or oculovestibular (calorics)Signs of ICPMotor Response: posturing vs. purposeful movementsDTRsTreatment:Control airway, monitor VS, IV accessC-spine precautions, increase HOB if ICP, herniation suspected, hyperventilation, dexamethasone, neurosurgical consultGive thiamine (before dextrose in case of Wernicke’s), dextrose, naloxone, flumazenilDiagnostic Studies:Head CT, MRICXR, C-spineCBC, ESR, electrolytes, BUN, Cr, ABG, LFTs, coags, tox screen, TSH, VDRL, B12, folate, UA, UDSLumbar punctureEKG, EEGGlasgow Coma ScoreEye OpeningBest Verbal ResponseBest Motor ResponsePointsFollows commands6OrientedLocalizes pain5SpontaneousConfusedWithdraws from pain4To VoiceInappropriate wordsFlexor response3To Painful stimuliUnintelligible wordsExtensor response2NoneNoneNone1Causes of Metabolic AcidosisM: MethanolU: UremiaD: DKAP: ParaldehydeI: InfectionL: Lactic AcidosisE: Ethylene gylcolS: SalicylatesAEIOU M&M TIPSA: Alcohol E: EpilespyI: InsulinO: Overdose, oxygenationU: Uremia, underdoseM: MI&: AnesthesiaM: MetabolicT: TraumaI: InfectionP: Psych, poisoningS: Stroke, shock ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.