Dr. House
This condition causes an altered LOC, has a sudden onset, fluctuating symptoms, is assessed for every shift and any time neuro changes occur.
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 with flushed skin 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 89%, glucose pending.
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.
What are the signs and symptoms of shock? Shock results in decreased cerebral perfusion due to the reduced MAP, and decreased cerebral blood flow,
This vital sign abnormality worsens cerebral perfusion in sepsis.
What is hypotension – Low MAP decreases cerebral blood flow resulting in an altered LOC?
A patient with a history of asthma, ESRD, DM II presents to the ER with confusion, lethargy, nausea and asterixis (flapping tremor)
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.
You receive report from ER on a patient that has an altered LOC, tachycardia, hyperthermia (autonomic instability) and hyperreflexia.
What is serotonin syndrome (SSRI)? Triad of symptoms: alerted LOC, autonomic hyperactivity, neuromuscular abnormalities.
This condition can cause an altered LOC due to the increased cerebral metabolic demand and result in neuronal injury. The priority intervention requires antipyretics and a aquathermia pad.
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 oxygen administration.
What is hypoxia? Oxygen deprivation causes immediate brain dysfunction.
A patient presents to the ER with a confusion, sluggish motor movements including flapping of the hands, and lethargy. Past medical history includes HTN, 26 pack year history, alcohol abuse and hypothyroidsm.
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.
An elderly patient is admitted with hypothermia, bradycardia, hypotension, hyponatremia, hypoglycemia, and progressive unresponsiveness
What is a myxedema coma?
In severe non - induced hypothermia, this clnical sign indicated a poor prognosis.
What is absence of shivering? The loss of shivering reflects failure of thermoregulation and CNS depression.
This metabolic cause presents with altered LOC such as agitation, hallucinations and tremors.
What is alcohol withdrawal?
Often triggered by stress trauma or physiological conditions, and can have a gradual onset, twitching motor movements of the arms, and legs,
What are functional seizures? seizures that are associated with an increased connection between limbic or emotional brain areas and higher-level motor networks. Commonly are associated with biopsychosocial stressors and are not caused by epileptic abnormality.
There are two main types of functional seizures:
With movements – typically the patient has thrashing movements that look just like a generalised epileptic seizure (previously called ‘grand mal’)
Without movements – in these attacks patients fall down to the ground and lie motionless and unresponsive, often for many minutes. Some people also have staring episodes.
Long duration of attacks
The nature of abnormal movements of head and limbs if there are any
The presence of a prolonged period of unresponsiveness
The appearance of eyes and mouth during the attack
Whether any warning before the attack. “Warnings” before functional seizures can be of variable length. Their duration can vary from being completely absent, to several hours. There is sometimes a pattern of escalating and frightening physical symptoms before an attack, often with dissociative symptoms (see below and the page on ‘dissociation’).
Patients with functional seizures often find it even harder to describe their attacks than patients with epilepsy
A patient presents to the ER with a confusion, sluggish motor movements, and lethargy. Past medical history includes HTN, 26 pack year history, alcohol abuse and hypothyroidsm.
What is TNK?
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 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 is on a propofol, fentanyl and versed infusion with a decreased LOC. The infusions have been titrated down with minimal change in LOC. Vital signs are withing 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 Lumbar puncture and administration of antibiotics and antivirals without delay?