AMS 1 Flashcards
1
Q
Glasgow Coma Scale (GCS)
- 15
A
Best score
2
Q
GCS
8 or lower
A
Comatose
3
Q
GCS
3
A
Unresponsive
4
Q
AMS is present in up to ___% of elderly hospitalized patients
- (elderly >__ years of age)
A
50%
- 65 yrs
5
Q
3 origins of AMS
A
- Medical
- Neurologic
- Psychiatric
6
Q
Other names of AMS
A
- ALOC
- Encephalopathy
- Confusion
- Delirium
- Acute confusional impairment
- Neurocognitive disorder (dementia)
- Organic brain syndrome
7
Q
7 levels of consciousness
A
- Alert
- Clouding of consciousness
- Confusional state
- Lethargic / Somnolent
- Obtunded
- Stuporous / Semicomatose
- Comatose
8
Q
Which level of AMS/LOC?
- Awake & fully aware of surroundings
- Responds appropriately to normal stimuli
- Does not imply capacity to focus attention
A
Alert
9
Q
Which level of AMS/LOC?
- Very mild form of altered mental status
- Inattention and reduced wakefulness
A
Clouding of consciousness
10
Q
Which level of AMS/LOC?
- More profound deficit
- Disorientation, bewilderment, difficulty following commands
A
Confusional State
11
Q
Which level of AMS/LOC?
- Not fully alert / drifts off to sleep when not stimulated
- Spontaneous movements decreased
- Awareness limited
- Unable to pay close attention, loses train of thought
- “confabulating”
A
Lethargic / Somnolent
12
Q
Which AMS / LOC?
- Difficult to arouse & when aroused is confused
- Constant stimulation required to elicit minimal cooperation
A
Obtunded
13
Q
Which AMS / LOC?
- Does not arouse spontaneously
- Requires persistent & vigorous stimulation
- When aroused, will moan/mumble
A
Stuporous / Semicomatose
14
Q
Which AMS / LOC?
- Unarousable, unresponsive to stimuli (reflexes)
- GCS usually less than 8
A
Comatose
15
Q
____ is common & associated w/ substantial morbidity for older people & often unrecognized
A
Delirium
16
Q
Incidence of delirium is highest in which patients?
(up to 70%)
A
ICU patients
17
Q
- Disturbance in attention / awareness
- Disturbance develops over a short period of time (hrs to days) and fluctuates during course of day
- Additional disturbance in cognition
A
DSM V for Delirium
18
Q
7 Risk Factors for Delirium
A
- Age (over 65)
- Male
- Dementia
- Functional impairment in activities of daily living
- Medical comorbidities
- Hx of excessive ETOH use (associated w/ withdrawal)
- Sensory impairment (vision/hearing) so, have pt’s hearing aids/glasses available immediately after procedures/surgeries
“65 yr old male w/ dementia having a bad day bc of his comorbidities, so he drinks ETOH and has withdrawals, and he can’t hear or see anything”
19
Q
A
20
Q
- Which infections lead to Delirium?
- Which medications lead to Delirium?
A
- Urinary Respiratory (PNA)
- Meds: Opioids, Benzos, anticholinergics
21
Q
When taking a hx for pt w/ Delirium, be sure to do a medication review (especially which 3 things?)
A
- Rx
- OTC
- ETOH
22
Q
W/ delirium, ETOH withdrawal usually occurs ___ hours after their last drink. Can be as soon as ___ hours if the patient is a heavy drinker and their withdrawal sxs would include: ____.
A
- Usually 48 hours
- Soon as 24 hours
- Hallucinations
23
Q
Do people w/ delirium from ETOH withdrawal usually experience hypothermia or hyperthermia?
A
Either
24
Q
- When ordering labs for pt w/ delirium, what 3 things are you looking for?
- Which one thing does not cause delirium?
A
- Hypernatremia
- Hypoglycemia
- Hypercalcemia
- NOT: Hyperkalemia
25
When checking an ABG on a pt w/ delirium, what would you be looking for?
Hypercapnia
26
4 labs for Delirium
* CBC
* Electrolytes
* Renal function tests
* Liver function tests
27
Consider ordering what 3 things for delirium?
* Brain imaging
* EEG
* CSF
28
* When maintaining behavioral control in pts w/ Delirium, what should be avoided?
* Which 2 meds should only be used if they are absolutely necessary?
* Avoid restraints
* Small doses of Haloperidol or Quetiapine
29
Which drugs should be reduced/eliminated in pts w/ delirium?
* Alcohol
* Anticholinergics
* Some antidepressants
* Antihistamines
* Anticonvulsants
* Antiparkinsonian agents
* Antipsychotics
* Barbiturates
* Benzos
* H2 blockers
* Opioid analgesics
30
**Delirium or Dementia?**
* Memory impairment
* Progressive / insididious onset
Dementia
31
**Delirium or Dementia?**
* Memory Impairment
* Disturbance of consciousness
* Acute / Rapid onset
* Fluctuation of sxs during 24 hr period
Delirium
(everything except progressive/insidious onset)
32
* Hypoxemia
* Hypoglycemia (DM pts w/ insulin overdose)
* Sepsis
* Hypertensive encephalopathy
* Wernicke's encephalopathy
* Overdose
* CNS infections / trauma
* Intracranial hemorrhage
* Epilepsy
**Life threatening** etiologies of AMS
33
* UTI
* PNA
Electrolyte abnormalities
* Meds effect / interaction
* Medication withdrawal
* Psych illness
Common Conditions as etiologies of AMS
34
* Endocrine disease (thryoid/adrenal)
* Stroke w/o focal motor deficit
* CNS mass
* Dementia
"other" etiologies of AMS
35
AMS Mnemonics
## Footnote
**AEIOU-TIPS**
* Alcohol, acidosis
* Epilepsy, endocrine
* Infection
* Overdose, oxygen deprivation
* Uremia
* Trauma, tumor
* Insulin (hyper/hypoglycemia)
* Stroke, space occupying lesion
36
AMS mnemonic
## Footnote
**DEMENTIA**
* Drugs
* Electrolytes
* Metabolic
* Emotional (psych)
* Neurologic, nutritional
* Trauma, tumor, temp
* Infection
* Alcohol
37
AMS Mnemonic
## Footnote
**MOVE STUPID**
* Metabolic
* Oxygen (hypoxemia)
* Vascular
* Electrolyte, endocrine
* Seizure
* Tumor, trauma, temp, toxin
* Uremia
* Pscyhiatric
* Infection
* Drugs (withdrawal)
38
* What is the most common electrolyte / metabolic abnormality of AMS?
* What can result if this abnormality is corrected too quickly?
**Hyponatremia**
(profoundly low sodium, if corrected too quickly can result in demyelination of central pontine and can result in death)
39
Besides hyponatremia (MC abnormality of AMS), what else should be considered?
Hypercalcemia
40
3 pre-existing systemic diseases of AMS
* DM
* Thyroid
* Cirrhosis
41
6 Emotional/Psych disorders associated w/ AMS?
* Neurocognitive disorder
* Dementia
* Delirium
* Wernicke's encephalopathy
* Conversion disorder
* Psychosis
42
Thiamine deficiency from ETOH abuse
Wernicke's encephalopathy
43
What is usually the most helpful diagnostic study for AMS when assessing head trauma?
CT (need to assess spinal cord injury)
44
When performing a rectal exam when assessing a patient w/ AMS after head trauma,
* if the sphincter tone is intact, the injury is likely \_\_\_\_\_.
* if little or no tone, there may be \_\_\_\_
* Intracranial
* Coexisting spinal cord injury
45
46
* W/ hypothermia, skin temp is near __ F
* What 4 things associated w/ hypothermia from AMS?
* If temp is 92-86F, results in what 3 things?
* 91 F
* Peripheral vasoconstriction, shivering, cardiovascular changes, respiratory changes
* Apathy, lethargy, ataxia
47
**_Hyperthermia_**
* **Heat exhaustion:** core temp may be normal or \< \_\_\_F
* 3 signs of heat exhaustion
* **Heat stroke:** core temp above \_\_\_F
* 4 signs of heat strroke
* **\<106F**
* Orthostatic hypotension
* Tachycardia
* Sweating
* **106F**
* Same as heat exhaustion + CNS dysfunction
48
* High suspicion of infection in which 2 age groups?
* Elderly pts get which 2 infections?
* Infants get which infection?
* Pts may be \_\_\_\_\_.
* Need to identify and tx quickly!
* Very young or very old
* **Elderly:** UTI or PNA
* *Infants:** meningitis
* Febrile
49
* Produces a metabolic encephalopathy similar to that produced by \_\_\_\_\_\_\_\_.
* **Acute intoxication of alcohol** produces metabolic enc similar to that produced by **sedative-hypnotic drugs.**
50
Apart from "metabolic encephalopathy," what are 4 other side effects of Acute Alcohol Intoxication?
* **Peripheral vasodilation**
* **Tachycardia**
* **Hypotension**
* **Hypothermia** (pt passes out in cold weather)
51
* Most mild signs / sxs of acute alcohol intoxication?
* Most severe signs / sxs of acute alcohol intoxication?
(BAL = blood alcohol level)
* **Mild (20-50):** Diminished fine motor coordination
* **Severe (400):** Respiratory depression
