Altered mental status (peds): Difference between revisions
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== Background == | == Background == | ||
*Both cerebral cortices must be affected to cause AMS | |||
*AVPU scale | *Both cerebral cortices must be affected to cause AMS | ||
**Alert (GCS 15) | *AVPU scale | ||
**Responsive to verbal stimuli (GCS 13) | **Alert (GCS 15) | ||
**Responsive to painful stimuli (GCS 8) | **Responsive to verbal stimuli (GCS 13) | ||
**Responsive to painful stimuli (GCS 8) | |||
**Unresponsive (GCS 3) | **Unresponsive (GCS 3) | ||
== DDX == | == DDX == | ||
*AEIOU TIPS | |||
**Alcohol | *AEIOU TIPS | ||
**Encephalopathy | **Alcohol | ||
**Insulin | **Encephalopathy | ||
**Opiates | **Insulin | ||
**Uremia | **Opiates | ||
**Trauma | **Uremia | ||
**Infection | **Trauma | ||
**Poisoning | **Infection | ||
**Poisoning | |||
**Seizure | **Seizure | ||
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== Work-Up == | == Work-Up == | ||
*Labs | *Labs | ||
**Glucose, CBC, chem, UA, CSF, LFT, utox, VBG, BAL, thyroid | **Glucose, CBC, chem, UA, CSF, LFT, utox, VBG, BAL, thyroid | ||
*ECG | *ECG | ||
*Neuroimaging | *Neuroimaging | ||
== Treatment == | == Treatment == | ||
*Immobilize cervical spine for suspected trauma | |||
*Fluid resuscitation 20 mL/kg x3 as needed; start pressors thereafter | *Immobilize cervical spine for suspected trauma | ||
*Abx for sepsis or meningitis | *Fluid resuscitation 20 mL/kg x3 as needed; start pressors thereafter | ||
*Naloxone for opiate or clonidine overdose (0.01-0.1 mg/kg IV q2 min) | *Abx for sepsis or meningitis | ||
*Flumazenil for pure benzo overdose (0.01 mg/kg IV) | *Naloxone for opiate or clonidine overdose (0.01-0.1 mg/kg IV q2 min) | ||
*Glucose for hypoglycemia (2 mL/kg of 25% dextrose) | *Flumazenil for pure benzo overdose (0.01 mg/kg IV) | ||
*Avoid sodium bicarbonate for metabolic acidosis unless pH | *Glucose for hypoglycemia (2 mL/kg of 25% dextrose) | ||
*Control seizures | *Avoid sodium bicarbonate for metabolic acidosis unless pH <7.0 | ||
*Control seizures | |||
*Prevent hypothermia, treat hyperthermia | *Prevent hypothermia, treat hyperthermia | ||
==See Also== | == See Also == | ||
[[Altered Mental Status (AMS)]] | |||
[[Altered Mental Status (AMS)]] | |||
== Source == | |||
Tintinalli | |||
Tintinalli | |||
[[Category:Peds]] | [[Category:Peds]] [[Category:Neuro]] | ||
[[Category:Neuro]] | |||
Revision as of 17:18, 15 November 2011
Background
- Both cerebral cortices must be affected to cause AMS
- AVPU scale
- Alert (GCS 15)
- Responsive to verbal stimuli (GCS 13)
- Responsive to painful stimuli (GCS 8)
- Unresponsive (GCS 3)
DDX
- AEIOU TIPS
- Alcohol
- Encephalopathy
- Insulin
- Opiates
- Uremia
- Trauma
- Infection
- Poisoning
- Seizure
| A | Alcohol | O | Opiates |
| Acid-base and metabolic disorders | U | Uremia | |
| Diabetes mellitus | Chronic renal failure | ||
| Dehydration | Hemolytic-uremic syndrome | ||
| Hypercapnia | T | Trauma | |
| Hepatic failure | General trauma with hypovolemia | ||
| Hypoxia | Head injury | ||
| Inborn errors of metabolism | Mass lesion | ||
| Arrhythmia and cardiogenic causes | Cerebral edema | ||
| Ventricular fibrillation | Cerebrovascular accident | ||
| Adams-Stokes attack | Electric shock | ||
| Aortic stenosis | Decompression sickness | ||
| Pericardial tamponade | Tumor | ||
| E | Encephalopathy | Thermal extremes | |
| Hypertensive encephalopathy | I | Infection | |
| Reye syndrome | Meningitis | ||
| Hemorrhagic shock and encephalopathy syndrome | Encephalitis | ||
| Brain abscess | |||
| Postimmunization encephalopathy | Visceral larva migrans | ||
| Disseminated encephalomyelitis | Severe systemic infection | ||
| Human immunodeficiency virus disease | Intracerebral vascular disorders | ||
| Subarachnoid hemorrhage | |||
| Endocrinopathy | Venous thrombosis | ||
| Addison disease | Arterial thrombosis | ||
| Congenital adrenal hyperplasia | Intracerebral or intraventricular hemorrhage | ||
| Thyrotoxicity | |||
| Cushing syndrome | Cerebral embolus | ||
| Pheochromocytoma | Acute infantile hemiplegia | ||
| Hepatic porphyrias | Acute confusional migraine | ||
| Electrolyte imbalances | Moyamoya malformation | ||
| [Na+], [Ca2+], [Mg2+], PO4 |
P | Poisoning | |
| I | Insulin | Psychogenic unresponsiveness | |
| Hypoglycemia | S | Seizure | |
| Ketotic hypoglycemia | Shunt malfunction |
Work-Up
- Labs
- Glucose, CBC, chem, UA, CSF, LFT, utox, VBG, BAL, thyroid
- ECG
- Neuroimaging
Treatment
- Immobilize cervical spine for suspected trauma
- Fluid resuscitation 20 mL/kg x3 as needed; start pressors thereafter
- Abx for sepsis or meningitis
- Naloxone for opiate or clonidine overdose (0.01-0.1 mg/kg IV q2 min)
- Flumazenil for pure benzo overdose (0.01 mg/kg IV)
- Glucose for hypoglycemia (2 mL/kg of 25% dextrose)
- Avoid sodium bicarbonate for metabolic acidosis unless pH <7.0
- Control seizures
- Prevent hypothermia, treat hyperthermia
See Also
Source
Tintinalli