Module 9: AMS Flashcards
etiology of AMS, primary neurologic
stroke, seizure (postictal, status, non convulsive, infection (meningoencephalitis, abscess), epidural/subdural hematoma, concussion, hydrocephalus, completed migraine, venous thrombosis, cholesterol or fat emboli, CNS vasculitis, TTP (thrombotic thrombocytopenia purpura)
etiology of AMS, systemic (especially found in elderly)
- cardiac: Sever CHF, HTN encephalopathy
- pulmonary: decreased PaO2, increased PaCO2
- GI: liver failure, constipation, Wilson’s
- Renal: uremia, hypo-/hyper natremia
- endocrine: decreased glucose, DKA, HHNS, increased Ca, hypo or hyperthyroidism, Addisonian crisis
- ID: PNA, UTI, sepsis
- hypo/hyperthermia
- medicaitons especially opiates & sedatives
- ETOH & toxins
assessment of AMS
- history: previous/recent illnesses, including underlying dementia or psychiatric disorders, head trauma, medications, drug/alcohol use
- general PE: signs of trauma, stigmata of liver disease, embolic phenomena, signs of drug use, nuchal rigidity (do not test if concern for trauma/cervical spine injury)
what is confusion (encephalopathy)
unable to maintain coherent thought process
what is delirium
waxing/waning confusional state w/ additional sympathetic signs
what is drowsiness
decreased level of consciousness, but rapid arousal to verbal or noxious stimuli
stupor?
impaired arousal to noxious stimuli, but some preserved purposeful movements
coma?
sleep-like state of unresponsiveness w/ no purposeful responses to stimuli
delirium vs dementia?
delirium:
- abnormal mental state/not a disease
- usually due to drug use or life-threatening condition
- causes: medication, infection, drug use, organ failure, surgery, hospitalization, disease processes, poisons
dementia?
- decline in mental ability severe enough to interfere w/ daily life
- braid disease not an inevitable outcome of aging
- Alzheimer’s is most common followed by vascular
features of delirium
Onset: acute course: fluctuating duration: days-weeks consciousness: altered attention: impaired reversibility: usually hallucinations: frequent identifiable causes: frequent
features of dementia:
onset: insidious
course: progressive
duration: lifelong
Consciousness: clear
attention: normal
reversibility: rarely
hallucinations: rare
identifiable cause: rare
what’s included in a neuro exam?
-observation for spontaneous movements, response to stimuli, papilledema
cranial nerves: eye position at rest, response to visual threat, corneal reflex, facial grimace to nasal tickle, cough/gag
-pupil size and reactivity: pinpoint ->opiates. mid position & fixed -> midbrain lesion. fixed & dilated –>severe anoxic encephalopathy, herniation
-motor response in extremities to noxious stimuli - noting purposeful or posturing
-DTR, babinski response
what is intact oculecephalic
doll’s eyes, eye movement opposite head movement. or
what is oculovestibular
cold calorics = eye move toward lavaged ear, implies brainstem intact
