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Nayla Foundations Exam 4 > AMS > Flashcards

AMS Flashcards

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1
Q

What does AOx4 mean

A

Alert: LOC and response to stimuli
Oriented: to person, place, and time +/- situation

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2
Q

If LOC is impaired, what is it due to

A

bilateral cerebral dysfunciton (oriented) OR

reticular activating system (Alert)

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3
Q

What are the levels of consciousness

A 
Alert
Lethargic/somnolent 
obtunded
stuprose
coma
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4
Q

What is delerium

A

Acute (hr-day) disturbance in attention and cognitive disturbance that is a direct physiological consequence of another medical condition

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5
Q

Delerium RF include

A 
Age
male
dementia
Hx high alcohol consumption 
sensory impairments
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6
Q

What can cause delerium

A 
Infection 
Withdrawal 
Acute vasculae 
Trauma 
CNS lesion 
Hypoxia 
Deficiency of vitamins 
Endocrine 
Acute metabolic 
Toxins 
Heavy metals 
(also fecal impaction, bed rest)
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7
Q

Effective delerium management should include

A

Prevention: avoid causes
ID & TX: infection, pain, fluid balance, sensory deprivation
Maintain behavior: sitter, reorient, reassure, music (NO RESTRAINTS)
Prevent complication: falls, malnutrition, pressure ulcers

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8
Q

What med can be used to maintain control

A

IF necessary, Haloperidol

*black box- increase mortality in elderly with dementia

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9
Q

What should you avoid to decrease risk of delerium

A 
alcohol
antipsychotics
benzos
opioids
anticholinergics
H2 blockers (ppi)
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10
Q

How does AMS present

A

confusion, lethargy, inattention, agitation, impulsivity, delusions, hallucination, sedation, change in behavior or personality

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11
Q

Causes of dementia include

A 
Drugs 
Electrolytes (Hyponatremia)
Metabolic
Emotional/psych 
Neuro/nutrition
Trauma, tumor, temp
Infection
Alcohol
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12
Q

Hypercalcemia is

A

cancer intil proven otherwise

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13
Q

When finding metabolic causes, look for

A

DM
thyroid disease
cirrhosis

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14
Q

Neuro Sx in AMS include

A

dysphasia
dysarthria
unilateral facial droop and decreased strength

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15
Q

What are trauma, temp, and tumor signs

A

Concussion (protect Spine with c collar)
CT Head and c spine
rectal exam

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16
Q

What can a rectal exam tell you

A

Sphincter intact= intracranial etiology

no rectal tone= spinal cord injury

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17
Q

What is hypothermia

A

skin <91 = peripheral vasoconstriction, shivering, AMS, changes in cardiac and pulmonary
86-92 = apathy, lethargy, ataxia

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18
Q

What is heat exhaustion

A

core temp 106 or below = orthostatic hypotension, tachy, diaphoresis

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19
Q

What is heat stroke

A

> 106 degrees = tachy, diaphoresis, orthostatic hypotension AND CNS dysfunction

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20
Q

What infections are common in age extremes

A

elderly: UTI, PNA
infant: meningitis
(may not be febrile)

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21
Q

Acute intoxication causes

A

metabolic encephalopathy similar to sedative hypnotics
Tachycardia + hypotension + hypothermia
(BAL 300= coma)

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22
Q

When do you attribute AMS to psych causes

A

when you have r/o stroke, mass lesion, confusion, and delerium

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23
Q

How do you evaluate AMS

A

ABC (and glucose)- vitals, mental status, pupil size, skin temp, HR, O2
Start interventions
Then complete H&P to determine cause

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24
Q

How do you treat AMS

A 
ID cause, Treat cause 
in the meantime; SNOT cocktail 
Sugar 
Naloxone (narcan) 
Oxygen
Thiamine (give before glucose)
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25
What is poisoning
predictable, dose dependent effects with a harmful agent | (usually accidental in kids 1-5)- intentional in adults
26
What are the MCC of toxic exposures
``` accidental ingestion (kids) accidental OD (elderly) intentional OD (suicide) secondary to psych disorder ```
27
History "matters" when determining cause
``` Material inhaled, ingested, or absorbed Amount taken Time Taken Emesis Reason S/Sx ```
28
Working in a garage often causes
CO poisoning
29
Applying chemicals to crops often causes
organophosphate poisoning
30
PE for poisoning will show 1 of two effects
``` Psychologic excitation (high HR, BP, RR, T) Physiologic depression (low HR, BP, RR, T) ```
31
What causes physiologic excitation
``` Anticholinergics Sympathomimetics Central hallucinogens Drug withdrawal (coke, meth, bath salts, PCP, LSD) ```
32
What causes physiologic depression
``` EtOH Sedative hypnotics Opiates Cholinergics Sympatholytics Toxic alcohols Ethylene Glycol (organophosphates, benzos, pain meds, methanol) ```
33
What will show mixed physiologic effects
``` Polydrug OD Metabolic poisons Heavy metals TCA (metformin, sulfonylurea, ASA, cyanide, iron) ```
34
What 2 physical exam findings can tell you a lot
pupil size, mydriatic or miotic | EOM's, nystagmus
35
What labs should you get for diagnosis
``` CBC Anion gap and MUDPILES BUN, CR Glucose LFT B-HCG ```
36
What shows up on a urine drug screen
``` opioids benzo coke thc barbituates amphetamines TCA buprenorphine ```
37
What do you need a serum screening for
``` APAP ASA digoxin lithium valporic acid iron, lead, mercury ```
38
What is a toxidrome
clinical syndrome essential to recognize poison pattern (s/Sx of a certain class)
39
What is general therapy for all poisoning
``` ABC Gastric lavage (before activated charcoal if ingestion <60 min prior and airway is protected) ```
40
When would you preform hemodialysis for poison therapy
``` amphetamines lithium methanol ASA theophylline phenobarbital ethylene glycol ```
41
How do you treat different poisons
inhaled: Oxygen Contaminated eyes: irrigation Contaminated skin: water and dilute soap Ingested: gastric lavage (NGT, OGT, PO charcoal)
42
What poison control numbers should you call
American Association of Poison Control Centers (1.800.222.1222) Banner Poison Control Center (602.253.3334)
43
What is a concussion
traumatic biomechanical force (+/- head trauma) causing rapid onset neuro dysfunction that resolves spontaneously +/- LOC, no imaging abnormalities
44
Who is most likely to sustain TBI
``` 0-4 y/o 15-19 y/o 65+ 75+ have highest rates of TBI death Males Soldiers from Iraqi war ```
45
Majority of sports injuries occur due to
Football! | also hockey, soccer, rugby
46
What is damage in a concussion due to
axonal injury from coup-contra coup | head back/brain forward- head forward/brain back
47
What are symptoms of a concussion
``` Confusion (answers slowly) memory loss visual disturbance (diplopia, photophobia) Impaired balance headache ```
48
Post concussive syndrome is
when symptoms last >1 week with cognitive difficulties and a cluster of physical and sleep symptoms
49
How do you diagnose concussion
clinically- CT only if LOC or GCS <15, or serious injury
50
What is different about athletes and concussions
they need to be evaluated by experienced clinicians (SCAT5) with specific protocol to return to play
51
What is the Brain Trauma Indicator
new lab test that measures proteins (UCH-LI and GPAP) released from the brain into blood w/in 12 hours of injury (Predicts patients that will show intracranial lesions on CT)
52
What is Tx for concussion
physical and mental rest + APAP | gradually increase activity
53
What is an EDH
blood accumulates between the dura and bone (IC or spinal)
54
When is an EDH an emergency (fatal)
if intracranial !
55
What is the pathophys of an EDH
linear force to skull causes periosteal dura to separate from bone= vessel damage usually skull Fx
56
Does expansion stop?
it is rapid, but stops at suture lines
57
What are symptoms of an EDH
delayed decline ALC, HA, N/V, Sz, focal neuro deficits (aphasia, weakness, numbness) Spinal EDH: weakness, change in DTR, sensory deficit with radicular paresthesias, bladder and bowel dysfunction
58
What will EDH PE show
increased ICP (bradycardia, HTN) skull Fx Hematoma raccoon eyes (basilar skull Fx) battle sign CSF otorrhea and rhinorrhea, hemotympanum Decerebrate, decorticate, altered GCS, weakness, Doll eye (oculocephalic reflex), anisocoria (ipsilat dilation), CN VII injury
59
Common brain herniations include
*Subfalcine (HA, contralateral leg weakness) Tonsillar (obtunded) Transtentorial (CN III ipsilat abn EOM and pupil/ contrala hemiparesis)
60
What are symptoms of a brain herniation
increased ICP causing Cushing's triad | HTN, resp depression, bradycardia
61
EDH workup includes
CBC Coags Tox screen type and screen (ab-ag for blood transfusion)
62
What will EDH CT show
midline shift- white aint right | LENS shaped
63
What is Tx for EDH
Emergent decompression (burrhole on side of DILATD pupil/injured side) Elevate head 30-45 +/- coagulopathy (FFP, Vitamin K, protamine)
64
How can you treat an intubated EDH patient
Hyperventilate = hypocapnia = vasoconstriction = decrease ICP *but, you increase ischemia
65
What meds can you use for an EDH
Diuretics (mannitol) or Hypertonic saline (for high ICP) Tylenol to decrease fever anticonvulsants for prophylaxis
66
What med can you give for a spinal EDH
high dose methylprednisone
67
What is the definitive Tx for EDH
Surgery; craniotomy or laminectomy to evacuate hematoma
68
What is a SDH
blood below inner dural layer, extending to brain and arachnoid
69
How can you categorize SDH
Acute <72 hours Subacute 3-7 days Chronic >7 days
70
Who often gets SDH
Elderly on anticoags s/p LP Spontaneous
71
What is the MOA of SDH
coup-contre coup: torn vessels (bridging veins) that connect surface of brain to dural sinus Chronic SDH related to cerebral atrophy
72
What can an SDH lead to
Herniation | small SDH resolve spontaneously
73
How does Acute SDH present
mod-severe injury comatose presentation depends on location
74
How does chronic SDH appear
insidious in 40+ y/o (older brain= more atrophy) | decreased LOC, HA, gait abn/imbalance, memory loss, personality changes, motor deficits, aphasia, seizure
75
What does a SDH PE show
``` GCS <15 with blunt head trauma (GET A CT) HA confusion nausea speech difficulty diplopia weakness ```
76
What does a SDH workup include
emergent non-con CT (when patient is stabilized) If GCS worsens by 2+ points, repeat imaging labs (same as EDH; CBC, coags, tox screen, type and screen)
77
MRI or CT for SDH
MRI is better, but CT is faster and more available
78
What does an acute SDH show on CT
CRESCENT shaped mass (white aint right) (hyperdense) | -chronic SDH is darker (isodense) and harder to see on CT
79
How do you treat an acute SDH
ABC osmotic diuretic surgical decompression
80
What is the prognosis of Acute SDH
poor; due to likely brain injury
81
Why do Acute SDH patients need ICU post op
strict BP control (dont want it to be too high and have them bleed again) ventilator respiration
82
What is Tx for chronic SDH
surgery not needed w/o mass effect or symptoms

Nayla Foundations Exam 4 (15 decks)

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