Altered mental status resident survival guide: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
Shown below is an algorithm summarizing the diagnosis of altered mental status according to the the American Academy of Neurology guidelines.<ref name="urlwww.loyolamedicine.org">{{cite web |url=https://www.loyolamedicine.org/sites/default/files/gme/internal-medicine/continuum_2011_altered_mental_status.pdf |title=www.loyolamedicine.org |format= |work= |accessdate=}}</ref><ref name="pmid21250221">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Tindall SC |title= |journal= |volume= |issue= |pages= |date= |pmid=21250221 |doi= |url=}}</ref> | Shown below is an algorithm summarizing the diagnosis of altered mental status according to the the American Academy of Neurology guidelines.<ref name="urlwww.loyolamedicine.org">{{cite web |url=https://www.loyolamedicine.org/sites/default/files/gme/internal-medicine/continuum_2011_altered_mental_status.pdf |title=www.loyolamedicine.org |format= |work= |accessdate=}}</ref><ref name="pmid21250221">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Tindall SC |title= |journal= |volume= |issue= |pages= |date= |pmid=21250221 |doi= |url=}}</ref><ref>{{cite journal|doi=10.5847/wjem.j.1920-8642.2012.04.006}}</ref><ref name="pmid23177603">{{cite journal |vauthors=Han JH, Wilber ST |title=Altered mental status in older patients in the emergency department |journal=Clin. Geriatr. Med. |volume=29 |issue=1 |pages=101–36 |date=February 2013 |pmid=23177603 |pmc=3614410 |doi=10.1016/j.cger.2012.09.005 |url=}}</ref> | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | A01 | | | |A01= Patient with amnesia | {{Family tree | | | | A01 | | | |A01= Patient with amnesia | ||
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==Do's== | ==Do's== | ||
*Perform | *Perform an ABCDEF evaluation as a first step. | ||
*If combative, use physical or chemical | *If combative, use physical or chemical restraining. | ||
*Take a non-contrasted CT scan of the head before contrasted when head trauma is suspected. | *Take a non-contrasted CT scan of the head before contrasted when head trauma is suspected. | ||
*Sodium imbalances should be slowly corrected to avoid a pontine myelinolisis or a brain herniation. | *Sodium imbalances should be slowly corrected to avoid a pontine myelinolisis or a brain herniation. | ||
| Line 46: | Line 47: | ||
==Don'ts== | ==Don'ts== | ||
*Do not | *Do not administer glucose before thiamine, when Wernicke encephalopathy is suspected. | ||
==References== | ==References== | ||
{{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}} | {{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}} | ||
Revision as of 20:34, 12 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.
Overview
Life threatening causes of altered mental status include malignant hypertension, myocardial infarction, rabies and sepsis. Other common causes of altered mental status include alcohol withdrawal, dehydration, electrolyte disturbance and hypoglycemia.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated
- Carbon monoxide toxicity
- Heat stroke
- Hypothermia
- Malignant hypertension
- Myocardial infarction
- Rabies
- Sepsis
Common Causes
- Alcohol withdrawal
- Drug withdrawal
- Dehydration
- Electrolyte disturbance
- Encephalitis
- Epileptic seizures
- Hyperglycemia
- Hypoglycemia
- Meningitis
- Sepsis
Diagnosis
Shown below is an algorithm summarizing the diagnosis of altered mental status according to the the American Academy of Neurology guidelines.[1][2][3][4]
| Patient with amnesia (Amnesia, confusion, loss of alertness, disorientation, disruption of judgement, behavior and perception) | |||||||||||||||||||||||||||||
| {{{ D01 }}} | Evaluate ABCDEF • Airway • Breathing • Circulation • Disability (Glasgow coma scale) • Exposure (Rapid head to toe revision) • Fingerstick blood glucose | {{{ D03 }}} | |||||||||||||||||||||||||||
Do's
- Perform an ABCDEF evaluation as a first step.
- If combative, use physical or chemical restraining.
- Take a non-contrasted CT scan of the head before contrasted when head trauma is suspected.
- Sodium imbalances should be slowly corrected to avoid a pontine myelinolisis or a brain herniation.
Don'ts
- Do not administer glucose before thiamine, when Wernicke encephalopathy is suspected.
References
- ↑ "www.loyolamedicine.org" (PDF).
- ↑ Walker HK, Hall WD, Hurst JW, Tindall SC. PMID 21250221. Missing or empty
|title=(help) - ↑ . doi:10.5847/wjem.j.1920-8642.2012.04.006. Missing or empty
|title=(help) - ↑ Han JH, Wilber ST (February 2013). "Altered mental status in older patients in the emergency department". Clin. Geriatr. Med. 29 (1): 101–36. doi:10.1016/j.cger.2012.09.005. PMC 3614410. PMID 23177603.