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
