AMS = Altered Mental Status

 

We will give here the classification  only since most of them are described elsewhere in the guide.

Etiology:

M -Metabolic Acid-Base abnormalities

N - Neuro (Stroke, Brain mass, SAH, Meningitis, Encephalitis)

P - Psyche (Catatonia, NMS, Serotonin syndrome)

T - Trauma  to  CNS

T - Temperature (hypo/hyperthermia)

S - Shock (Neurologic, Hypovolemic, Septic, Anaphylactic)

S - Seizure and postictal state

A - Alcohol, Toxin, Drugs

E - Endocrine (DM, Adrenal, Hypoglycemia, Thyroid, Pre-eclampsia)

E - Electrolytes (Hypo/Hypernatremia, Uremia, Ammonia, Hypoxia 2ry to pneumonia,
     PE   or  anemia)

I  - Infection (CNS, Sepsis)

DX:

  1. Vitals, Orthostatic, Temperature (rectal is preferred), GCS, FS (Finger Stix)
     
  2. Physical exam to look for the clues:  Pupils, Head injury, AOB, Jaundice, Otorrhea, Petechiae, Tongue laceration, Bone Fx (fat emboli), Needle tracks, Toxidrome.
     
  3. CBC, O2 SAT, Electrolytes, Ca, Mg, Ammonia, BUN, LFT
     
  4. ABG, UA, UPT
     
  5. Tox screen, C-spine as needed
     
  6. CT, Cxray, EKG (pericarditis/tamponade, PE)
     
  7. LP as needed

Treatment:

  1. ABC, O2, IVF
     
  2. Coma cocktail = Naloxone 0.01-0.2 mg/kg, D50, Thiamine 100 mg
     
  3. Specific treatment as guided by exam and/or work-up result

[BACK]