Altered mental status resident survival guide: Difference between revisions
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Revision as of 20:50, 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) | |||||||||||||||||||
| 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.[5]
- Sodium imbalances should be slowly corrected to avoid a central pontine myelinolysis or a brain herniation.[6][7]
Don'ts
- Do not administer glucose before thiamine, when Wernicke encephalopathy is suspected.[8]
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.
- ↑ Lee B, Newberg A (April 2005). "Neuroimaging in traumatic brain imaging". NeuroRx. 2 (2): 372–83. doi:10.1602/neurorx.2.2.372. PMC 1064998. PMID 15897957.
- ↑ "Central Pontine Myelinolysis Information Page | National Institute of Neurological Disorders and Stroke".
- ↑ Gankam Kengne, Fabrice; Decaux, Guy (2018). "Hyponatremia and the Brain". Kidney International Reports. 3 (1): 24–35. doi:10.1016/j.ekir.2017.08.015. ISSN 2468-0249.
- ↑ Merlin MA, Carluccio A, Raswant N, Dossantos F, Ohman-Strickland P, Lehrfeld DP (November 2012). "Comparison of Prehospital Glucose with or without IV Thiamine". West J Emerg Med. 13 (5): 406–9. doi:10.5811/westjem.2012.1.6760. PMC 3556948. PMID 23359624.