AMS Flashcards
(44 cards)
List the range of consciousness
- alert
- lethargic, somnolent
- obtunded
- stuporous, semicomatose
- comatose
not fully alert and drifts off to sleep when not stimulated, awareness limited, unable to pay close attention, loses train of thought constantly and consistently
Lethargic or Somnolent
difficult to arouse, and when aroused, is confused. Constant stimulation required to elicit minimal effort
obtunded
Does not arouse spontaneously, requires persistent and vigorous stimulation for very little response. When aroused, will moan or mumble.
- Stuporous or Semicomatose
unarousable unresponsiveness
coma
glasgow coma scale grades coma severity according to what 3 categories? highest score in each category?
- eye opening (4)
- motor (6)
- verbal responses (5)
List the GCS for eye opening
- 4= spontaneous
- 3 = to voice
- 2 = to pain
- 1 = none
List the GCS for motor response
- 6 = obeys commands
- 5 = localizes to pain
- 4 = withdraws from pain
- 3 = flexor posturing
- 2 = extensor posturing
- 1 = none
List the GCS for verbal response
- 5 = oriented
- 4 = confused
- 3 = inappropriate words
- 2 = incomprehensible sounds
- 1 = none
What is Decorticate posturing? Where is the brain damage
- Decorticate = flexion with adduction of arms and extension of legs => flexor response
- reflexts destructive lesion in corticospinal tract from cortex to uppermidbrain
What is Decerebrate posturing? Where is the brain damage
- extension, adduction, and internal rotation of arms and extension of legs => extensor posturing
- associated with damage to corticospinal tract at level of brainstem (pons or upper medulla)
Which is worse, decorticate or decerebrate posturing
Decerebrate
customary to intubate patient with a GCS of
- < or = 8
- likely they are unable to protect their airway
- very poor prognosis if < or = 8 longer than 72 hours
Define condition
- significant cognitive impairment in AT LEAST one of the following: learning, memoryn language, executive function, complex attention, perceptual motor function, and social cognition
- impairement is acquired and decline from previous functioning
dementia: major neurocognitive disorder
define condition
- disturbance in attention and awareness
- develops over a short period of time, and tends to fluctuate during course of day
- additional disturbance in cognition
- disturbance is caused by a medical condition, substance intoxication or withdrawal, or medication side effect
Delirium
are focal or lateralized neurologic findings characteristic of delirium?
NO
list the risk factors for delirium
- underlying brain disease
- age > 80
- infection
- taking multiple medications
- ETOH use
- Men
- fracture
differentiate between delirium and major neurocognitive disorder in terms of
- onset
- vital signs
- level of consciousness
- hallucination
delirium
- onset: rapid
- vital signs: often abnormal
- level of consciousness: altered
- hallucination: visual
dementia
- onset: slow
- vital signs: normal
- level of consciousness: normal
- hallucination: rare
list the etiology of AMS
MOVE STUPID
- Metabolic (hypo/hypernatremia, hypercalcemia)
- Oxygen (hypoxia)
- Vascular (CVA, bleed, MI, CHF)
- Endocrine (hypoglycemia, thyroid)
- Seizure
- Trauma, temperature, toxins
- Uremia
- Psychogenic
- Infection
- Drugs
what are interventions that should be done while you are getting your history and physical exam of a AMS patient
- oxygen
- finger stick glucose
- EKG
- IV, draw labs
What are labs that should always be ordered when assessing a patient with AMS
- electrolytes
- creatinine
- glucose
- calcium
- CBC
- UA
- pregnancy test
List the toxins that cause physiological excitation (CNS stimulation, elevation of HR, BP, RR, and Temp)
- anticholinergic
- sympathomimetics
- central hallucinogen agents
- ETOH withdrawal
List the toxins that cause physiological depression (CNS depression, reduction of HR, BP, RR, and Temp)
- ETOH, methanol, ethylene glycol
- sedative-hyponotics
- opiates
- cholinergics
- sympatholytics
list the procedures to enhance elimination of poisons
- forced diuresis
- urine ion trapping
- hemodialysis
- exchange transfusion
