Dr. House
This condition causes an altered LOC, hypoactive or hyperactive symptoms, has a sudden or progressive onset, fluctuating symptoms, and is assessed for every shift.
What is delirium?
This is the standardized scale used to determine the level of consciousness in patients.
What is the Glascow Coma Scale?
A patient becomes lethargic, abdominal breathing and bounding pulses. ABG shows pH 7.28, PaO₂ 89, PaCO₂ 68, HCO3 27. What is the cause of altered LOC?
What is hypercarbia/hypercapnia? -> Hypercapnia depresses the CNS and causes progressive somnolence; treatment focuses on improving ventilation, not oxygen alone. Treatment -> BiPap
Pinpoint pupils, respiratory depresion and altered LOC.
What is opioid intoxication/overdose? Reversal agent: naloxone (0.04mg to 2 mg IV, start at 0.1mg (intranasal 4 mg))
A 74-year-old patient becomes acutely lethargic,
RR 8, BP 82/40, SpO₂ 85%,
What is airway support and oxygen administration? Airway and oxygenation take priority over diagnostics; hypoxia and hypotension rapidly worsen cerebral perfusion. Then check blood glucose level.
When caring for the postictal patient, the MRP is notified if the post ictal phase is longer than?
What is 30 minutes?
On assessment of your patient, you find the patient has an altered LOC, hypotensive, tachycardic, with oliguria and cool clammy skin, all signs of this state.
What is shock? Shock results in decreased cerebral perfusion due to the reduced MAP, and decreased cerebral blood flow,
Often triggered by stress trauma or physiological conditions, typically thought to be "short-circuit" or dissociation leading to thrashing motor movements of the arms, and legs.
What are functional seizures or psychogenic non-epileptic seizures
A patient with a history of asthma, CKD, DM II presents to the ER with significant AKI, confusion, lethargy, nausea and no urine output.
What is uremic encephalopathy? Accumulation of nitrogenous wastes affecting the functioning of the CNS
This lab value is the first to be checked in any patient with an altered LOC.
What is blood glucose? Hypoglycemia mimics focal neurological deficits.
This condition causes your patient with a subdural hematoma to suddenly increase their urine output significantly more than earlier, leading to low urine osmolarity.
What is Diabetes Insipidus?
If not managed with antipyretics, this condition can cause an altered LOC due to the increased cerebral metabolic demand and result in neuronal injury.
What is hyperthermia? Cooling prevents further neuronal injury; antipyretics alone are ineffective.
Your patient with an altered LOC has a rapid improvement in their LOC after receiving dextrose.
What is hypoglycemia?
A patient presents to the ER with a confusion, restlessness, sluggish motor movements including flapping of the hands, and lethargy. Past medical history includes HTN and alcohol abuse.
What is hepatic encephalopathy? Liver dysfunction – unable to metabolize toxic substances, causing increase in build up of ammonia -> resulting in brain dysfunction
This electrolyte correction must be done slowly to prevent brain injury.
What is sodium correction? (4 mmol – 10 mmol in 24 hours). Rapid shifts can cause osmotic demyelination – cerebral edema – locked in syndrome, coma.
A postop. bowel resection patient with history of hypothyroidism is admitted with hypothermia, bradycardia, hypotension, hyponatremia, hypoglycemia, and progressive unresponsiveness
What is a myxedema coma?
This vital sign abnormality worsens cerebral perfusion in sepsis
What is hypotension – Low MAP decreases cerebral blood flow resulting in an altered LOC?
This condition presents with altered LOC such as agitation, diaphoresis, hallucinations and tremors.
What is alcohol withdrawal?
By administering 1L IV bolus, you may notice an improvement in level of consciousness and correct this hemodynamic instability.
What is hypotension?
Your patient is lethargic, moaning and blood sugar is 2.5
What is give an AMP of Dextrose
Why is the blood pressure not lowered aggressively in stroke patients?
What is the risk of cerebral ischemia?
In older patients, this may present as the first sign of sepsis.
What is an altered LOC?
A patient with a history of DM II, HTN, hyperlipidemia who has not refilled his prescriptions, presents to the ER with a severe headache, confusion, blurred vision, nausea and a flushed face.
What is a hypertensive encephalopathy? In severe hypertension there is failure of cerebral autoregulation, which leads to cerebral edema and altered LOC.
An intubated patient is on a Fentanyl and Versed infusion. The infusions have been titrated down with minimal change in LOC. Vital signs are within normal range except for RR. This intervention can be anticipated next with caution.
What is Flumazenil?
CNS Depression: Monitor respiratory rate (RR), O2 sats, mental status, and level of consciousness (LOC). Use with extreme care; it's contraindicated or risky if the patient has been using benzos long-term (risk of precipitating severe withdrawal/seizures)
The priority management for a patient with a fever, headache, altered LOC and photophobia.
What is a lumbar puncture and administration of antibiotics and antivirals without delay?