Altered level of consciousness Flashcards Preview

Internal Medicine > Altered level of consciousness > Flashcards

Flashcards in Altered level of consciousness Deck (14):
1

What is altered mental state

Disorders of mental functioning: from confusion to coma

2

What is mental status

1. Level of consciousness, attentiveness
2. Cognition, mental processes or thoughts

3

Confusion

1. Disoriented, bewildered, having difficulty following commands

4

Somnolent

1. Sleepy, responds with only incoherent mumbles/disorganised movements

5

Obtunded

1. Lessened interest in environment, slow response to stimulation

6

Stuporous

1. Profoundly reduced alertness, continuous noxious stimuli required for arousal

7

Comatose

1. State of seep, unarousable, sustained unconsciousness

8

Urgent considerations/differentials

1. Acute neurological event: TIA/stroke, THI, IC bleed, seizures, meningitis/encephalitis, abscess, encephalopathy, delirium
2. Severe systemic infection
3. GIT: surgical abdomen
4. Cardiac: MI, CCF, arrythmias
5. Psychiatric
6. Respiratory: hypoxia, asthma, COPD, PE, pneumonia, respiratory depression, drowning
7. Medication
8. Toxidromes/drugs: alcohol, sedatives, PCP
9. Endocrine: myxedema, Addison's
10. Metabolic: sodium, potassium, calcium
11. GLUCOSE

9

Management

1. Basic life support: ABCDEFG
Oxygen
IV access
Vitals
2. History
Previous cognition
Functional status
Medication
Comorbid
Pain
Alcohol and drug use
Non-specific irritability
Environmental
3. Physical examination
4. Preliminary investigations:
Glucose, FBC, UEC, TFTs, Urinalysis
CXR
Drug screen/drug levels if n digoxin, lithium, quinidine
ECG + troponins
ABG
LFTs
Cultures if suspect, ?LP (neck stiff, rigid)
Pelvic imaging if suspect hip fracture
Consider other investigations if appropriate: CT/MRI
5. Admit if appropriate

10

4 cardinal signs of delirium

1. Acute and fluctuating
2. Inattention
3. Disorganised thinking
4. ALOC

11

Diagnosis and management ALOC and smelling of alcohol

1. Hypoglycemia
Check glucose
Thiamine
Glucose
2. Head injury
Extra/subdural hematoma
Neurological obs, CT
3. Other general medical conditions
Seizure, acute poisening, meningitis/infection, CVA, trauma, hypothermia
4. Acute in chronic alcoholics
Pneumonia
Cardiac
GIT hemorrhage, encephalopathy
Pancreatitis
HypoK, hypoMg, hypoCa
Wildrawal/delirium tremens
Ketoacidosis
Acidic acidosis
Renal failure
Wernickes

12

Management in unconscious patient

1. ABCDEFG, cardiorespiratory resus if required
Clear obstruction
Airway patent->chin lift, jaw thrust, OPA...
Cardiac monitoring
2. Include C-spine stabilisation if any suggestion of face, head or neck trauma
3. Remove clothing, prevent heat loss
4. IV cannula + bloods
FBC, coags, UEC, blood glucose, ELFTs, culture/drug screen
ABGs
5. 50ml of 50% dextrose if hypoG
6. Vitals + temp
7. Consider naloxone, flumazenil, glucose, thiamine
8. Consider critical conditions
Tension pneumothorax: intercostal
Cardiac arrythmia: ECG and treat
Exsanguination: cross match + fluids + USS
Anaphylaxis: Remove allergen + lay flat + Adrenalin 0.5 ml (0.5mg) adult IM
Extradural hemorrhage: airway + CT + neurosurg
9. NGT
10. Catheter

13

Most common causes of unconscious

1. Poisening
2. Hypoglycemia
3. Post-ictal
4. Stroke
5. Head injury
6. SAH
7. Respiratory failure
8. Hypotension/shock

14

Less common causes of unconscious

1. Meningitis/encephalitis
2. Hepatic or renal failure
3. Septicemia
4. Subdural