Exam 2 ALTERED MENTAL STATUS Flashcards Preview

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Flashcards in Exam 2 ALTERED MENTAL STATUS Deck (40):
1

Levels of Consciousness? (5)

Alert
Lethargic/Solemn
Obtunded
Stupor
Coma

2

Alertness includes?

Doesn't include?

awake and aware,
N response to stimuli

Ability to focus attention

3

ABCD of initial eval?

Airway
Breathing
Circulation
Dextrose (get FSBS)

4

AVPU is?

Neuro test:
Alert, Verbal, Painful, Unresponsive

5

Initial intervention for coma includes? (3)

O2
IV access/Fluid resuscitation
Coma Cocktail:
Thiamine + D50W + Naloxone

6

Coma Cocktail response tells us?

If wakes w/i 2-3 min = hypogly or opiate OD

No response = keep looking

7

Labs for coma? (8)

ABG
BAL
Blood CX
CBC
CMP
CSF
Drug screen
UA

8

Studies for coma? (3)

EKG
CXR
CT

9

Physical exam for coma includes? (8)

Vitals repeated often

Order of exam:
Skin (temp, text, tracks)
Neck (meningeal, JVD)
Chest (breath, heart, wall integrity)
Abd
Extrem (stable pelvis, movement)
Neuro (GCS, CNs, reflex, pupils, anal sphincter)
Psych

10

Breath odors tell us:

Fruity?

Bitter almond?

Rotten eggs?

Oil/Gas?

Fluor green, no odor?

Fruity = DKA, Nitrites, isoprop alcohol

Bitter almond = cyanide

Rotten eggs = hydrogen sulfide

Oil/Gas = hydrocarbons

Fluor green, no odor = ethylene glycol

11

Cholingergic Poisoning:

Caused by?

Sx onset?

Results in?

Tx?

Cause: organophos, nn gas, mushrooms

Onset: 8 hrs

Results: seizure, coma, resp/card fail

Tx: 2-PAM or Atrophine

12

Cholingergic Poisoning: Presentation?

DUMBELS

Defection
Urination
MM weakness
Bradycard, Bronchorrhea, Bronchospasm
Emesis
Lacrimation
Salivation

13

Anticholingergic Poisoning:

Caused by?

Tx?

Causes: TCA, Antipsych, Antihist, Jimson weed

Tx: monitor/support

14

Anticholingergic Poisoning: Presentation?

Hot as a hare (fever)
Blind as a bat (mydriasis)
Dry as a bone (↓BS, urine retent, dry muc mem)
Red as a beet (flushing)
Mad as a hatter (toxic psychosis)

15

TCA Poisoning:

Presentation?

Tx?

Pulmonary edema
Antichol sxs
AV block (Na/K chan block)
HypoTN
Confusion, Halluc, Seizure, Coma

EKG monitor
Activate charcoal
Sodium bicarb
BZs

16

Opioid Poisoning:

Presentation?

Tx?

CNS depr, miosis, resp depress

Vent support, Naloxone

17

Sympathomimetic Poisoning:

Caused by?

Presentation?

Tx?

Cocaine, Meth

Psychomotor agitation, mydriasis, diaphoresis, tachy, HTN, rhabdomyolysis, MI

Cooling, sedation, hydration

18

Antidotes:

Acetaminophen?

Antichol?

BZs?

β-block?

CCB?

Digoxin?

Heavy metals?

Narcotics?

Acetaminophen = acetylcystine

Antichol = physostigmine

BZs = Flumazenil (Ramazicon)

β-block = glucagon

CCB = Ca2+

Digoxin = Digibind

Heavy metals = chelation

Narcotics = Naloxone

19

Sedative-Hypnotic W/D caused by?

BZs and barbs

Result of abrupt stop after long use or high doses

20

Sedative-Hypnotic W/D presentation?

Agitiation
Tremor
N/V
Tachy
Hallucinations
Flushing

21

Sedative-Hypnotic W/D tx?

Short-acting barb then long in equiv dose

Pentobarb 300mg PO or 200 mg IM until aroused ->

Phenobarb PO tapered over 10 days

22

Seizures from W/D caused by?

U earliest sign of EtOH w/d (b/w 6-48 hrs)

May become DTs

23

Seizures from EtOH W/D presentation?

U focal
U pt still responsive to verbals
Rare loss of bowel/bladder
No post-ictal state

24

Seizures from EtOH W/D tx?

U self-limit
Close observation 24 hrs
If repeat seizure, single dose Phenobarb or Valium
*Dilantin doesn't work

25

e- Abnormalities that cause AMS?

Presentation?

U hypoNa+ < 120

Delirium, drowsiness, seizure, coma

26

Metabolic causes of AMS? (4)

Endocrine
Hepatic
Renal
Thyroid storm

27

Metabolic AMS presentation?

Mental status flux w/ lucid periods,
No focal abnormalities
Visual halluc
Recent memory not intact

28

AMS Presentation resulting from Acute Psych Disorders? (4)

U recent memory retention intact
Able to perform simple calculations
Auditory halluc
U a/w drug/alcohol

29

Thrombotic Thrombocytopenia Purpura presentation?

Tx?

Acute fever, bleed/rash, renal fail, neuro ∆s
C 20-40yo F
Related to vWF

plasma exchange + steroids

30

Acute head trauma rectal exam tells us?

If tone intact = likely intracranial injury
If ↓ or no tone = coexisting spinal cord injury

31

HYPOthermia is?

Presentation?

Skin temp ~ 91F

Periph vasoconst
Shivering
Mental status ∆
CV ∆
Resp ∆
Apathy, Lethargy, Ataxia

32

HYPERthermia is:

Exhaustion?

Exhau: Core temp N to < 106
Ortho hypoTN, tachy, sweating

Stroke: Core temp > 106
Same + CNS dysf

33

Typical Infection AMS causes in elderly?

Infants?

urosepsis, PNA

meningitis, sepsis

34

Inflamm causes of AMS?

SLE
Giant cell arteritis
Sarcoidosis

35

Acute intoxication presentation?

Metabolic encephalopathy
Periph vasodil
Tachy
HypoTN
HYPOTHERMIA

36

Acute intoxication stupor occurs at what BAL in non-chronics?

250-300 mg

37

Wernicke's is?

Presentation?

Tx?

EMERGENCY
Acute thiamine deficiency w/ carbohydrate ingestion from alcoholism, malnutrition or both

Ophthalmoplegia, nystag, ataxia, confusion,
Peripheral Neuropathy

38

Wernicke's tx?

Thiamine IV (P) + Mg
Rest to protect CV

39

DT's are?

Presentation?

LIFE THREATENING
From EtOH w/d (3-4 days post)

Significant delirium w/ tremors, agitiation,
Purposeless activity,
Visual halluc,
Tachy,
Dilated pupils
Fever, Sweating

40

DT tx? (4)

Thiamine IV/IM
Fluids
Vit C/B
Librium to prevent seizures