Altered mental status (geriatrics): Difference between revisions

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==Infectious==
==Infectious==
'''Encephalitis'''
'''Encephalitis'''
*mental status changes - personality/behavior changes
*Mental status changes - personality/behavior changes
*unlikely to have fevers, meningismus
*Unlikely to have fevers, meningismus
*high risk: same for meningitis, live near water  
*High risk: same for meningitis, live near water  


'''Meningitis'''
'''Meningitis'''
*usually other etilogy for AMS, but if negative workup do LP
*Usually other etiology for AMS, but if negative workup do LP
*consider ampicillin for listeria
*Consider [[Ampicillin]] for listeria
*consider acyclovir for HSV
*Consider acyclovir for HSV
*high risk: HIV, DM, Malignancy, s/p [[ceftriaxone]], prior NSG, alcoholism, recent sinusitis
*High risk: HIV, DM, malignancy, s/p [[ceftriaxone]], prior NSG, alcoholism, recent sinusitis


'''Pneumonia'''
'''Pneumonia'''
*false negative CXR ~15-20%
*False negative CXR ~15-20%
*high morbidity   
*High morbidity   


'''UTI'''
'''UTI'''
*very common etiology for AMS in elderly
*Very common etiology for AMS in elderly
*straight cath
*Straight cath UA
*resistant organisms likely, look up old UCx + sensetivity   
*Resistant organisms likely, look up old UCx + sensetivity   
*high risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, hx prostate CA  
*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, hx prostate CA  


'''Cholecystitis'''
'''Cholecystitis'''
* may not have RUQ pain or GI sxs
*May not have RUQ pain or GI sxs
* ask about hx of gallstones/US RUQ
*Ask about hx of gallstones/US RUQ


'''Skin/Soft Tissue'''
'''Skin/Soft Tissue'''
*completly undress to examine
*Completly undress to examine
*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 11:47, 25 July 2015

Background

  • Elderly patients present differently with common issues
  • Unique aspects of elderly AMS
  • See AMS for complete differential 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 etiology 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 UA
  • 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 withdrawal

Polypharmacy

  • NSAIDS - may be taking multiple
    • Long term ASA
  • Steroids
  • Sedative/Psychoactives
  • Anticholinergics - many OTC
    • Meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, diphenhydramine
    • 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

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