Description
The evaluation of a patient with altered mental status begins with a detailed history. Because the patient may be unable to offer a history, it will be required to seek additional information from family, friends, or the primary medical team. The first step is to ascertain the timing of the mental status change and the circumstances surrounding it, such as medication/drug usage or trauma. An acute change in mental state is a medical emergency that necessitates an immediate, systematic evaluation. Airway, breathing, and circulation ("ABC's") should be evaluated in conjunction with an updated set of full vital signs and finger-stick blood glucose. Tachycardia may indicate a systemic infection, pulmonary embolism, or atrial fibrillation with high ventricular rate.
Résumé
- The presentation discusses the approach to patients with altered mental status in the emergency department, emphasizing the importance of differentiating between delirium, dementia, and psychosis. Delirium is characterized by acute onset, fluctuating attention, and an underlying organic cause, while dementia is a slow, progressive neurodegenerative disorder. Psychosis involves a loss of contact with reality, often accompanied by auditory hallucinations.
- The primary aim in the emergency department is to identify and treat life-threatening conditions. This includes assessing airway, breathing, circulation, disability, and exposure (ABCDE approach). Rapidly correctable causes, like hypoglycemia and hypoxia, should be addressed promptly.
- History-taking from reliable caregivers is essential, focusing on the patient's baseline mental status, medications, and substance use. Physical examination includes assessing for trauma, meningeal signs, cardiac issues, systemic infections, liver disorders, and neurological deficits. The CAM method can be used to quickly assess for delirium.
- Management involves providing a safe and calm environment, and using restraints (physical or chemical) if necessary. Chemical restraints, such as benzodiazepines (lorazepam) or antipsychotics (haloperidol), can be used to safely control behavior for treatment. Laboratory investigations are guided by the patient's presentation and suspected causes.
- Complications of altered mental status include aspiration pneumonia, pressure ulcers, deep vein thrombosis, malnutrition, and cognitive impairment. The treatment of altered mental status depends on the underlying cause, such as sepsis, stroke, or meningitis. Early and aggressive treatment improves patient outcomes.
Exemple de certificat
À propos des intervenants
Docteur Priyanka Mahale
Médecin consultant en médecine d'urgence, hôpital Paras, Kanpur
Divulgation financière
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