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><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>
Shown below is an algorithm summarizing the diagnosis of altered mental status according to the the American Academy of Neurology guidelines.
   
   
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*Perform an ABCDEF evaluation as a first step.
*Perform an ABCDEF evaluation as a first step.
*If combative, use physical or chemical restraining.
*If combative, use physical or chemical restraining.
*Take a non-contrasted CT scan of the head before contrasted when head trauma is suspected.<ref name="pmid15897957">{{cite journal |vauthors=Lee B, Newberg A |title=Neuroimaging in traumatic brain imaging |journal=NeuroRx |volume=2 |issue=2 |pages=372–83 |date=April 2005 |pmid=15897957 |pmc=1064998 |doi=10.1602/neurorx.2.2.372 |url=}}</ref>
*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 central pontine myelinolysis or a brain herniation.<ref name="urlCentral Pontine Myelinolysis Information Page | National Institute of Neurological Disorders and Stroke">{{cite web |url=https://www.ninds.nih.gov/Disorders/All-Disorders/Central-Pontine-Myelinolysis-Information-Page#:~:text=Central%20pontine%20myelinolysis%20(CPM)%20is,pulls%20water%20from%20brain%20cells. |title=Central Pontine Myelinolysis Information Page &#124; National Institute of Neurological Disorders and Stroke |format= |work= |accessdate=}}</ref><ref name="Gankam KengneDecaux2018">{{cite journal|last1=Gankam Kengne|first1=Fabrice|last2=Decaux|first2=Guy|title=Hyponatremia and the Brain|journal=Kidney International Reports|volume=3|issue=1|year=2018|pages=24–35|issn=24680249|doi=10.1016/j.ekir.2017.08.015}}</ref>
*Sodium imbalances should be slowly corrected to avoid a central pontine myelinolysis or a brain herniation.




==Don'ts==
==Don'ts==


*Do not administer glucose before thiamine, when Wernicke encephalopathy is suspected.<ref name="pmid23359624">{{cite journal |vauthors=Merlin MA, Carluccio A, Raswant N, Dossantos F, Ohman-Strickland P, Lehrfeld DP |title=Comparison of Prehospital Glucose with or without IV Thiamine |journal=West J Emerg Med |volume=13 |issue=5 |pages=406–9 |date=November 2012 |pmid=23359624 |pmc=3556948 |doi=10.5811/westjem.2012.1.6760 |url=}}</ref>
*Do not administer glucose before thiamine, when Wernicke encephalopathy is suspected.
*Do not asume psychiatric causes until other triggers are ruled out.


==References==
==References==
{{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}}
{{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}}
<references />

Revision as of 20:56, 12 August 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.

Overview

Altered mental status can result from a variety of factors, including alterations in the chemical environment of the brain, insufficient oxygen or blood flow in the brain, and excessive pressure within the skull. The level of consciousness may decline abruptly or slowly, or it may increase and decrease intermittently. 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

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of altered mental status according to the the American Academy of Neurology guidelines.

 
 
 
Patient with amnesia (Amnesia, confusion, loss of alertness, disorientation, disruption of judgement, behavior and perception)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate ABCDEF
• Airway
• Breathing
• Circulation
• Disability (Glasgow coma scale)
• Exposure (Rapid head to toe revision)
• Fingerstick blood glucose
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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 central pontine myelinolysis or a brain herniation.


Don'ts

  • Do not administer glucose before thiamine, when Wernicke encephalopathy is suspected.
  • Do not asume psychiatric causes until other triggers are ruled out.

References

Template:WikiDoc Sources

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