Altered Mental Status Presentation
Altered Mental Status (AMS) Quizlet
Reticular Activating System (RAS) → Series of neurologic circuits responsible for staying awake, paying attention, and sleeping; keeps a person alert and oriented.
Three requirements for normal CNS function → Oxygen, glucose, and water.
Causes of altered mental status → Deficiencies in oxygen, glucose, or water; trauma; infection; toxins; stroke; mass effect; problems in other body systems causing hypoxia.
Primary assessment priorities for AMS → Identify life-threatening problems, assess airway and breathing, consider oxygen, positioning, suctioning, and determine baseline mental status.
Secondary assessment for AMS → Examine patient thoroughly, perform body systems exam, obtain complete history.
Sources of information during AMS assessment → Family members, bystanders, medications, Medic Alert bracelets, health-related items.
Pediatric assessment question → "Are they acting differently than normal?"
Diabetes
Insulin → Hormone produced by the pancreas that allows glucose to enter cells for energy.
Function of insulin → Binds to receptors on cells and allows glucose to pass into cells.
Type 1 Diabetes Mellitus → Pancreas produces little or no insulin; treated with synthetic insulin.
Type 2 Diabetes Mellitus → Body's cells do not use insulin properly; treated with diet, oral medications, and sometimes insulin.
Hypoglycemia
Definition of hypoglycemia → Blood glucose less than 70 mg/dL.
Significant AMS is expected at what glucose level? → Less than 50 mg/dL.
Causes of hypoglycemia → Too much insulin, not eating enough, overexertion, vomiting, increased metabolic rate (fever or shivering).
Onset of hypoglycemia → Rapid.
Behavior associated with hypoglycemia → May mimic drunkenness.
Skin signs of hypoglycemia → Pale and diaphoretic.
Cardiovascular sign of hypoglycemia → Tachycardia.
Respiratory sign of hypoglycemia → Rapid breathing.
Neurologic complications of hypoglycemia → Seizures, altered mental status, unconsciousness, permanent brain damage.
Treatment for hypoglycemia → Safety first, airway management, support breathing, oral glucose if conscious, ALS/transport.
Hyperglycemia
Definition of hyperglycemia → Blood glucose greater than 140 mg/dL.
High blood glucose level associated with severe symptoms → Greater than 300 mg/dL for prolonged periods.
"HI" reading on glucometer → Greater than 500 mg/dL.
Causes of hyperglycemia → Decreased insulin, stress, increased dietary intake.
Onset of hyperglycemia → Develops over days to weeks.
Signs of hyperglycemia → Chronic thirst, hunger, increased urination, nausea, warm flushed skin.
Results of hyperglycemia → Dehydration, excessive waste products, diabetic ketoacidosis (DKA).
Treatment for hyperglycemia → Safety first, airway management, support breathing, ALS/transport.
Diabetic Emergencies
Diabetic ketoacidosis (DKA) → Severe hyperglycemia with profoundly altered mental status, dehydration, shock, Kussmaul respirations, and acetone odor on the breath.
Kussmaul respirations → Deep, rapid respirations associated with DKA.
Acetone odor on breath → Fruity odor characteristic of DKA.
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) → Severe hyperglycemia without Kussmaul respirations or acetone odor.
Blood Glucose Values
Normal blood glucose range → 70–120 mg/dL.
Hypoglycemia → Less than 70 mg/dL.
Severe hypoglycemia → Less than 50 mg/dL.
LOW glucometer reading → Less than 15 mg/dL.
Hyperglycemia → Greater than 140 mg/dL.
Severe hyperglycemia → Greater than 300 mg/dL.
HI glucometer reading → Greater than 500 mg/dL.
Patient Assessment
History questions for diabetic patients → Onset, duration, associated symptoms, trauma, seizures, fever, medications, insulin use.
SAMPLE history → Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up to illness.
Clues suggesting diabetes → Medical identification bracelet, insulin, medications, insulin pump.
Important diagnostic test in diabetic emergencies → Blood glucose monitoring.
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Sepsis and Septic Shock
Sepsis → Collection of problems caused by the body's response to infection.
Sepsis is similar to what condition? → Anaphylaxis.
Sepsis is what type of problem? → Systemic problem.
Severe sepsis causes what cardiovascular effects? → Systemic vasodilation and decreased cardiac output.
Septic shock results from → Severe infection causing circulatory collapse.
Stroke
Stroke → Interruption of blood flow to part of the brain.
Two major types of stroke → Ischemic and hemorrhagic.
Ischemic stroke → Caused by blockage of blood flow to the brain.
Hemorrhagic stroke → Caused by bleeding within the brain.
Transient Ischemic Attack (TIA) → Temporary blockage of blood flow causing stroke-like symptoms that resolve completely.
TIA symptoms usually resolve within → Minutes, always within 24 hours.
Sudden stroke symptoms → Weakness, numbness, confusion, trouble speaking, trouble seeing, loss of balance, severe headache.
Cincinnati Prehospital Stroke Scale
Facial droop test → Ask the patient to smile or grimace.
Pronator drift test → Ask patient to close eyes and extend both arms for 10 seconds.
Speech test phrase → "You can't teach an old dog new tricks."
Abnormal findings on the Cincinnati Stroke Scale suggest → Stroke.
FAST-ED Stroke Assessment
Important information to determine in stroke patients → Time of symptom onset or last known well.
If symptoms began less than 5 hours ago → Activate a Stroke Alert.
Head of stretcher should be elevated to → 30 degrees.
Transport priority for stroke patients → Do not delay transport for ALS intercept.
Seizures
Partial seizure → Involves one area of the brain; patient may remain conscious.
Generalized seizure → Involves the entire brain and affects consciousness.
Tonic-clonic seizure → Generalized seizure with muscle rigidity and rhythmic jerking.
Postictal phase → Period after seizure when consciousness gradually returns.
Aura → Smell, sound, or unusual sensation that may precede a seizure.
Status epilepticus → Seizure lasting longer than 10 minutes or two or more seizures without regaining consciousness.
Causes of Seizures
Common causes of seizures → Hypoxia, stroke, traumatic brain injury, toxins, hypoglycemia, infection, brain tumors, metabolic disorders, epilepsy, eclampsia, heat stroke.
Types of Seizures
Complex partial seizure → Often preceded by an aura.
Generalized tonic-clonic seizure → Most commonly recognized seizure type.
Syncope and Dizziness
Syncope → Brief loss of consciousness followed by spontaneous recovery.
Duration of most syncopal episodes → Seconds to a few minutes.
Patients often experience what before syncope? → Warning signs that the episode is coming.
Causes of syncope → Cardiovascular, environmental, toxicological, hypovolemic, metabolic, structural causes.
Common cardiovascular causes of syncope → Bradycardia, tachycardia, and vasovagal syncope.
Cause of syncope is never identified in approximately → Half of all cases.
Syncope Assessment
Questions to ask a syncopal patient
Did you have nausea?
Did you experience strong emotions?
Did you injure yourself?
Did anyone witness seizure activity?
Syncope Management
Patient management for syncope → Oxygen as needed, call ALS, loosen tight clothing, lay patient flat, treat injuries, assess blood glucose and stroke scale.
Poisoning
Signs of inhaled poison exposure
Difficulty breathing
Chest pain
Coughing
Hoarseness
Dizziness
Headache
Confusion
Altered mental status
Seizures
Alcohol Abuse
Delirium Tremens (DTs) → Serious alcohol withdrawal syndrome occurring after abrupt cessation of drinking.
Signs of alcohol withdrawal
Profuse sweating
Seizures
Hypertension
Tachycardia
Alcohol withdrawal may also cause → Tremors and hallucinations.
General Patient Care
Important treatments for AMS patients
Monitor vital signs
Treat for shock
Gather history
Watch for seizures
Transport to a medical facility