Altered mental status (geriatrics): Difference between revisions
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*Elderly patients present differently with common issues | *Elderly patients present differently with common issues | ||
*Unique aspects of elderly AMS | *Unique aspects of elderly AMS | ||
*See AMS for complete list | *See AMS for complete differntial list | ||
*Dementia should be diagnosis of exclusion | |||
==Infectious== | ==Infectious== | ||
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'''UTI''' | '''UTI''' | ||
*very common etiology for AMS in elderly | *very common etiology for AMS in elderly | ||
*straight cath | |||
*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''' | ||
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* ask about hx of gallstones/US RUQ | * 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== | ==Metabolic/Toxic/Polypharmacy== | ||
| Line 44: | Line 50: | ||
*Anticholinergics- many OTC | *Anticholinergics- many OTC | ||
**meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, benadryl | **meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, benadryl | ||
**dietary - teas | **dietary - teas, supplements | ||
'''Other''' | '''Other''' | ||
*Cardiac Ischemia - no chest pain needed | |||
*Seizure v Post ictal | *Seizure v Post ictal | ||
*urinary retention - uremia | *urinary retention - uremia | ||
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AMS | AMS | ||
==Source== | ==Source== | ||
ACEP Academic Affairs Committee Geriatric Video lecture series | |||
SAEM Academy of Geriatric Emergency Medicine | |||
Revision as of 23:12, 25 January 2013
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 ctx, 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
AMS
Source
ACEP Academic Affairs Committee Geriatric Video lecture series SAEM Academy of Geriatric Emergency Medicine