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Flashcards in [HYHO] HPS 1 Deck (40)
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1

What scale is used to describe general level of consciousness in patients with TBI or other head injury?

Glascow Coma Scale

2

What are the 3 parameters of the Glascow Coma Scale? What are the maximum scores for each?

Eye opening - 4

Best Verbal response - 5

Best Motor response - 6

3

How are the parameters for Glascow Coma Scale scored?

Individually

E.g. E2V3M4 = GCS 9

4

What are the GCS scores for mild, moderate, and severe brain injury?

>13 = Mild

9 to 12 = Moderate

<8 = Severe

5

How is GCS scored for intubated patients?

Scored with a "T" bc no verbal response (intubated)

Min - 2T

Max - 10T

6

Delirium or Dementia?

Richmond Agitation-Sedation Score

Delirium

7

What is the purpose of using the Richmond Agitation-Sedation Score?

Screen level of alertness in a mechanically ventilated patient

Used before CAM-ICU or bCAM in Delirium Triage Screen

8

Delirium or Dementia?

Confusion Assessment Method (CAM)

Delirium

9

What screening test allows non-psychiatrists to detect delirium in high risk environments?

Confusion Assessment Method (CAM)

10

What are the 4 features required for a positive CAM?

1 - Acute onset and fluctuating course

2 - Inattention

3 - Altered Level of Consciousness

4 - Disorganized thinking

Must have features 1 AND 2 + either 3 OR 4

11

What are the 3 steps to performing the Richmond Agitation-Sedation Scale?

1. Observe pt. Are they alert and calm (score 0)? Agitated/combative (+)? Difficult to arouse (-)?

2. If pt not alert, loudly state pt's name and direct them to open eyes and look at speaker. 

3. If pt does not respond to voice, physically stimulate by shaking shoulder and rubbing sternum

12

How are the positive scores on the Richmond Agitation-Sedation Scale described?

+4 - overtly Combative or violent, immediate danger

+3 - very agitated, aggressive to staff

+2 - Agitated, frequent nonpurposeful movement

+1 - Restless, anxious

13

How are the negative scores of the Richmond Agitation-Sedation Scale described?

-1: Drowsy>10 sec awake with eye contact and response to voice

-2: Light sedation<10 sec awakens with eye contact to voice

-3: Mod sedation, Any movement to voice (no eye contact)

-4: Deep sedation, no response to voice but responds to physical stimulation

-5: Unarousable, no response to any stimulation

14

Delirium Triage Screen vs bCAM

Which is more sensitive? Specific?

Sensitive - Delirium Triage Screen

Specific - bCAM

15

Dementia or Delirium?

Onset: Slow

Course: Progressive

 

Dementia

16

Dementia or Delirium?

Abnormal physical exam

Visual hallucinations

Delirium

17

Dementia or Delirium?

Disturbance in attention/cognition

Evidence of cause by medical condition, substance intoxication/withdrawal, medication side effect

Delirium

18

Avoid ______ to treat delirium, except in alcohol withdrawal

Benzodiazepines!!!!

19

What is the strongest risk factor for dementia?

Advanced age

20

Review: Most common cause of dementia?

ALZHEIMER'S DZ

never forget

21

In general for dementia, decline in ______ precedes decline in ______

In general for dementia, decline in cognition precedes decline in function

22

When diagnosing dementia, you must first rule out _____

When diagnosing dementia, you must first rule out depression

23

What are the two classes of drugs used to treat dementia?

NMDA receptor antagonist - memantine

Cholinesterase inhibitors - donepezil, rivastigmine, galantamine

24

What kind of dementia is characterized by progressive course, prominent memory loss, symmetric neurological exam?

Alzheimer's dementia

25

What kind of dementia is characterized by asymmetric neurological exam, risk factors/hx of stroke?

Vascular dementia

26

What kind of dementia is characterized by 2/3 of the following: parkinsonism, fluctuating cognition, well-formed visual hallucinations?

Lewy body dementia

27

What is the criterion for Parkinson's disease with dementia?

Parkinson's dz diagnosis precedes dementia by at least 1 year

28

What is the "I WATCH DEATH" mnemonic used for?

Differentia dx of delirium

29

What does "I WATCH DEATH" stand for?

I____

W____

A____

T____

C___

H___

D___

E___

A___

T___

H___

 

I-nfection

W-ithdrawal

A-cute metabolic

T-rauma

C-NS pathology

H-ypoxia

D-eficiencies

E-ndocrinopathies

A-cute vascular

T-oxins or drugs

H-eavy metals

30

Dementia scoring: Mini-cog

Components (2)

1 - 3 item recall test

2 - clock drawing test

Higher sensitivity for detecting MCI than MMSE, less affected by age and education levels, short (3 min)