emergency medicine—the ams patient - .docVIP

Emergency Medicine—The AMS Patient AMS AMS is very challenging because patients have alterations in cognitive ability, level of consciousness, or both. Pre-hospital personnel, family, witnesses, and old medical records can assist in evaluation. Prompt evaluation and treatment are necessary to decrease morbidity and mortality Etiology Systemic disorders – acid-base or metabolic, endocrine, electrolytes, uremia, and psychogenic Substance related disorders CNS disorders – encephalopathy, trauma, tumor, or infection Pathophysiology Consciousness involves the cerebral cortex, which is needed for cognition, and the RAS in the brainstem, which gives us our level of consciousness. Any deficit in level of consciousness indicates injury to RAS or cerebral hemispheres and can leads to AMS Definitions Conscious – alert and oriented to person, place, and time Inattention, mild confusion, disorientation Confusion – a clouded sensorium. Intellectual functioning is decreased Delirium – inattentive, agitated patients. May hallucinate and have delusions Obtundation – reduced alertness accompanied by extreme sleepiness. Can respond to painful stimuli Coma – unresponsive to stimuli or inappropriate response. Can be due to brain lesions or metabolic disorders Diagnostic Tests History and physical exam – pre-hospital personnel, family, bystanders GCS – eye opening, verbal response, motor response Pupil response – constricted may indicate overdose, dilated may indicate brain dysfunction Muscle tone and strength CN testing, sensory exam MMSE Respiratory patterns Management ABCs Identify etiology SMA7, B12, thiamine CT head Treat etiology Haloperidol/Ativan Supportive treatment DIABETIC EMERGENICES Hypoglycemia Hypoglycemia leads to brain injury. Etiology includes liver failure, CHF, adrenal insufficiency, diabetes, drugs such as insulin, sulfonylureas, aspirin, alcohol, or endocrine tumors (Insulinoma) Clinical Manifestations Sweating Shaking Anxiety Nausea Dizziness Confusion