Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading content…
Transcript

Change in mental status

Consciousness/Arousal

  • Arousal:
  • alert-drowsiness-stupor-coma
  • vague terms
  • Coma:
  • GCS scale
  • Mimics: akinetic mutism, locked-in, catatonia
  • Delirium
  • can be E4V5M6
  • disorientation+in-attension+fluctuation due to underlying disease
  • Dementia
  • progressive cognitive impairment

Consciousness/arousal

Etiology of decreased responsiveness

Neurologic vs Systemic

-neurologic: focal sign, rapid onset, truama

-Systemic: progressive, medication, fever

Etiology

Systemic

各次專科想一遍

medication/toxin

psychiatric

systemic

Neurologic

with focal signs

stroke, ICH, VST, PRES, pituirtary apoplexy

vascular

Seizures

Neurologic

meningitis, encephalitis, abscess

infection

TBI, concussion

trauma

autoimmune

Alzheimers, CJD

degeneration

venous sinus thrombosis

VST

  • life threatening
  • pregnancy, oral contraceptive, hypercoagulant
  • new onset severe headache=>seizures, stroke
  • Rx: IV heparin

from uptodate

pituitary hypoplexy

腦下垂體中風

  • pituitary adenoma+ shock, postpartum
  • severe headache, visual defect, hypotension
  • Rx: high dose steroid=>emergent OP

pituitary apoplexy

from sematic scholar

Posterior reversible encephalopathy syndrome[PRES]

PRES

  • a clinical radiographic syndrome
  • unclear, but it appears to be related to disordered cerebral autoregulation and endothelial dysfunction
  • headache, confusion or decreased level of consciousness, visual changes, and seizures
  • posterior cerebral white matter edema

AEIOU TIPS

A Alcohol, Anemia 酒精、貧血

E Electrolyte imbalance (NaCaMg) 電解質不平衡

I Insulin 高低血糖

O opiates, Oxygen (hypoxemia) 嗎啡類藥物, 低血氧

U Uremia 尿毒症

T Trauma, temperature, tumor 外傷, 體溫, 腫瘤

I Infection (meningitis, encephalitis, sepsis) 感染

P Psychogenic 精神因素

S Seizure, Stroke 癲癇, 中風

AEIOU

TIPS

Initial evaluation

initial evaluation

History

1. LQQ OPERA: tempo, premobid sx

2. Meds

3. ABC

4. Past/personal/family/OP history

5. TOCC

PE

  • vital sign(breathing pattern, pulse)
  • trauma(battle sign, raccoon eyes, CSF rhihorrhea, hemotympanum, ecchymosis)
  • neurologic(GCS, pupil, Babinski sign)
  • cormobidity

PE/NE

from uptodate

Initial treatment

1. Empirical Abx

2. Thiamine 100mg IV=> dextrose 50g IV

(naloxone 0.01mg/kg, flumazenil 0.2mg)

3. If C spine fracture=>immobilization

4. Head trauma四寶: mannitol, tranexemic acid, anti-epileptics, codeine

5. If tumor edema: dexamethasone 1pc IV and Q6H

initial treatment

Diagnostic study

All patient:

1. 血液: CBC/DC

2.biochemistry: BUN/Cr, Na/K/Ca/Mg, sugar, liver function test, toxin, ABG

3.Urine: urine routine, toxin

Diagnostic study

If clinical suspicion:

1. hepatic encephalopathy: ammonia

2. thyroid storm/ myxedema: TSH, free T4

3. adrenal insufficiency: cortisol

4. Wernicke encephalopathy: Vit B12

5. HIV combo test

6. SLE encephalopathy: ANA

7. infection: B/C

8. neurologic sign: brain CT C(-)

9. CNS infection: lumbar puncture

10.non-convulsive seizures: EEG

Treatment of delirium

1. Treat the underlying disease

2. stimulation and good sleep

3. prevent infection, restraint

4. Anti-psychotics if need

Rx of delirium

Learn more about creating dynamic, engaging presentations with Prezi