Altered mental status (geriatrics): Difference between revisions
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*consider ampicillin for listeria | *consider ampicillin for listeria | ||
*consider acyclovir for HSV | *consider acyclovir for HSV | ||
*high risk: HIV, DM, Malignancy, s/p | *high risk: HIV, DM, Malignancy, s/p [[ceftriaxone]], prior NSG, alcoholism, recent sinusitis | ||
'''Pneumonia''' | '''Pneumonia''' | ||
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*often decubs present | *often decubs present | ||
**old photos helpful | **old photos helpful | ||
*consider fistula, osteo, necrotizing | *consider fistula, osteo, necrotizing | ||
==Metabolic/Toxic/Polypharmacy== | ==Metabolic/Toxic/Polypharmacy== | ||
Revision as of 06:19, 27 February 2014
Background
- Elderly patients present differently with common issues
- Unique aspects of elderly AMS
- See AMS for complete differntial list
- Dementia should be diagnosis of exclusion
Infectious
Encephalitis
- mental status changes - personality/behavior changes
- unlikely to have fevers, meningismus
- high risk: same for meningitis, live near water
Meningitis
- usually other etilogy for AMS, but if negative workup do LP
- consider ampicillin for listeria
- consider acyclovir for HSV
- high risk: HIV, DM, Malignancy, s/p ceftriaxone, prior NSG, alcoholism, recent sinusitis
Pneumonia
- false negative CXR ~15-20%
- high morbidity
UTI
- very common etiology for AMS in elderly
- straight cath
- resistant organisms likely, look up old UCx + sensetivity
- high risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, hx prostate CA
Cholecystitis
- may not have RUQ pain or GI sxs
- ask about hx of gallstones/US RUQ
Skin/Soft Tissue
- completly undress to examine
- often decubs present
- old photos helpful
- consider fistula, osteo, necrotizing
Metabolic/Toxic/Polypharmacy
Withdrawl/Overdose
- chronic opiate/Benzo/Ambien use
- Etoh abuse - may not experience tremors in withdrawl
Polypharmacy
- NSAIDS - may be taking multiple
- long term ASA
- Steroids
- Sedative/Psychoactives
- Anticholinergics- many OTC
- meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, benadryl
- dietary - teas, supplements
Other
- Cardiac Ischemia - no chest pain needed
- Seizure v Post ictal
- urinary retention - uremia
- fecal impaction
- occult mesenteric ischemia
- Ca/Mg/Phos
See Also
Source
ACEP Academic Affairs Committee Geriatric Video lecture series SAEM Academy of Geriatric Emergency Medicine