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Flashcards in ALOC Deck (79)
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1

DDx in these pt’s is broad

i. Infection
ii. Intoxicated
iii. Confused
iv. Agitated, violent
v. Neurologic
vi. Traumatic
vii. Psychiatric


altered pts are brought for Diagnosis, protection, stabilization, intervention, disposition

2

organic issue

= medical issue

3

functional issue

psychiatric

4

Disturbed level and content of consciousness

delirium or demetnia

Delirium

Delirium is a transient disorder characterized by impaired attention, perception, thinking, memory, and cognition.

5

Gradual onset

delirium or dementia

Dementia

6

Easily distracted, poor attention span

delirium or dementia

delirium

7

Multiple cognitive defects: memory, language, attention, orientation, visual-spatial

Dementia

8

visual hallucinations psych or organic?

a. Visual hallucinations are usually not psychiatric

9

Slower onset, acute changes, exacerbations

psych

10

mixed disorder

= Psych plus drug abuse

11

ddx to consdier with ALOC

 Alcohol, withdrawal
 Epileptic Seizure
• Post-ictal state
 Insulin (glucose)
 Opiates, other drugs
 Uremia, liver failure
 Trauma
 Infection**
• Especially the elderly
 Psychiatric
 Shock

12

Red Flags

SICK
old/young/immunocompramisEd

PE findings:
falls, trauma
rash stiff neck
focal neuro

evidence or hx of seizure

toxidrome

PMHhx

meds

13

characteristics of delirium (8)

rapid onset
disorientation
memory loss
flucuaing ALOC
social immodesty
sxs worse a night
VISUAL HALLUCINATION
don't forget ETOH w/d

14

ALOC protocol (7)

pulse ox
d stick
upreg
u tox
ETOH level
bowel sounds
tachy-EKG
pupils
temperature

CAN you reverse it with NARCAN or Glucose?

15

observation and info

what do you see
hear from EMS
5150
past visits to ED
do they have DMC?

16

history that you should get

what happened?
pain?
sick?
medical problems?
fall trauma?
meds?
are you taking them?
have you used drugs or alcohol today?
ORIETNATIon ?s

17

orientation questions

see anything unusual?
orientation?

do you know where you are?

do you know the date?
months?
year?

who is the president?

18

traumatic ALOC hx

mechanism
when? once or ore?
did you lose consciousness
what did you do after it happened?
how do you feel now?
what hurts?
HA? vomiting?
can you walk?

19

HX from family and friends

onset fast or slow?
how different from normal?
happened before?
PMHx? meds ? psych hx?
recent illness or trauma?
witnessed LOC?
drus?
etoh?
delusions or paronia?
recent emotional stress?
hx of suicide attempts?
anything that could help me?

20

PE

vitals: EMS, triage, repeat

appearance, undress heat to toe

get permission, explain, go slow
look for toxidrome

GCS

21

GCS score

7-9 is significant
dead people get a 3
document

22

GCS categories and how many points are they worth

eye opening (4)
verbal (5)
motor (6)

23

eye opening graded on

spontaneous
to voice
to pain
none

24

verbal

oriented
confused
inappropriate
incomprehensible
none

25

motor categories

obeys commands
localizes
withdraws
flexes
extends to pain
none

26

APVU

awake
verbal
pain
unresponsive

27

what is the ALOC (6)

Vitals
d stick
pulse ox
upreg
urinte tox
etoh

28

what are you looking for in urine

blood
infections
ketones

29

when would you get a CK

– rhabdomyolysis (agitated, stimulants, down time)

30

when would you get a mag phos

ETOH involvement