Glucose level, ECG should be performed.E (Exposure): The findings should be evaluated in terms of trauma, transdermal drug tapes, dialysis intervention area, sources of infection and petechiae.Cervical stabilization should be provided if trauma is suspected. Administer benzodiazepines (lorazepam or diazepam, based on availability) in case of ongoing seizure activity. Check if the pupils are equal and reactive to light. D (Mini neurological evaluation): Assess Glasgow Coma Score (GCS) or AVPU quickly.If the patient is hypotensive, administer IV fluids and investigate the cause.
Capillary refill time, skin color and temperature may also help to understand possible shock situation. Check the distal pulses, blood pressure, and cardiac rhythm.
Approximately 3% of patients in the emergency department have impaired mental status. The altered mental state may mean coma, confusion, aggression, personality alteration, or difficulty in awakening. In sum, the normal state of consciousness requires a properly functioning brain stem and cerebral cortex.Īltered mental status may result from any changes in The cerebral cortex houses the cognition centers.
The Cognition is the combination of orientation, reasoning, and memory. The Ascending Reticular Activating System in the brainstem modulates arousal. Arousal refers to awareness of the self and the environment. The state of consciousness is a sum of arousal and cognition. General Approach and Critical Bedside Actions General Approach and Key Concepts A lumbar puncture is performed to diagnose or exclude meningitis. The abdomen is soft, non-tender, non-distended. The breath sounds are clear and equal bilaterally. The heart is irregularly tachycardic with no abnormal cardiac sounds. On a Glasgow Coma Scale, she is registered at 12 (E3, M5, V4) and she had neck stiffness. The pupils are reactive to light and equal in size. Physical Exam: She is in mild distress, lethargic and confusional with no lateralizing signs. Vital Signs: Blood Pressure: 110/70 mmHg, Heart rate: 110 bpm, respiratory rate: 20 rpm, temperature: 38.8 degrees Celsius, peripheral capillary oxygen saturation: 98%, finger-stick blood sugar: 95 mg/dL. Her only routine medications are angiotensin-converting enzyme inhibitors (ACE inhibitors) and insulins. The patient has a history of hypertension and diabetes mellitus. The caregivers express she was feverish and fatigued for several days now, but her mental problems have recently begun. By Murat Cetin, Begum Oktem, Mustafa Emin CanakciĪn 80-year-old female presents to the emergency department with a tendency to sleep ( altered mental status), failure in recognizing people and answering questions.