Acute_Mental_Status_Changes[1] 4.18.58 PM

Acute_Mental_Status_Changes[1] 4.18.58 PM - Acute Mental...

Info iconThis preview shows pages 1–11. Sign up to view the full content.

View Full Document Right Arrow Icon
Acute Mental Status Changes in the Intensive Care Unit Danagra Georgia Ikossi, MD Stanford General Surgery Resident 10/24/2006
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Just because you’re nuts, it doesn’t mean you’re not sick… the ongoing search for organic causes Brief review of Delirium, Seizures and Stroke “ICU Psychosis” How do you know if they’re confused? (J. Am. Ger. Soc. 2005) Why do they become delirious? (Critical Care 2001) Does delirium portend a poor outcome? (JAMA 2004) Geriatrics: Delirium plus dementia, what to do? (J. Am. Ger. Soc. 2005)
Background image of page 2
Disorders of Mentation Abnormalities of mental function Conciousness: Arousal (awake?) Awareness (responsive?) Cognition: Orientation (accurate perception of experiences) Judgment and Reasoning (ability to process data and generate meaningful information) Memory (ability to store and retrieve information)
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Levels of Conciousness Awake: aroused and aware Somnolent: easily aroused and aware Stuporous: aroused with difficulty, impaired awareness Comatose: unarousable and unaware Vegetative state: aroused but unaware
Background image of page 4
Etiology of depressed level of consciousness In non head injured patients SMASHED S ubstrate deficiencies (glucose, thiamine) M eningoencephalitis or M ental illness (malingering, psychogenic coma) A lcohol or A ccident (CVA) S eizures H yper-capnia, -glycemia, -thyroid, -thermia OR H ypo- xia, -tension, -thyroid, -thermia E lectrolyte abnormalities (hyperNa, hypoNa, hyperCa) and E ncephalopathies D rugs
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Verbal Oriented 5 Confused 4 Inappropriate 3 Incomprehensible 2 None 1 Eye Opening Spontaneous 4 To Speech 3 To Pain 2 None 1 Motor Obeys Commands 6 Localizes 5 Withdraws 4 Abnormal Flexion 3 Abnormal Extension 2 None 1 Glascow Coma Scale: GCS Max 15 Min 3 “T” denotes intubation
Background image of page 6
Predictive value of GCS at 1 hour: GCS <6, 70% will not regain “satisfactory neurologic recovery” At 3 days, GCS<6, 100% negative outcome
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Septic Encephalopahthy Can be caused by any infection aside from CNS infections Early sign of sepsis Advanced cases progress to multiple abscesses throughout brain matter Similar biochemical changes to hepatic encephalopathy Increased aromatic amino acids, decreased branched chain amino acids in plasma
Background image of page 8
Delirium Most common mental disorder in the hospitalized geriatric patient Up to 87% of elderly pts As many as 75% are not recognized by the physician caring for the patient Characterized by: acute mental status change and inattention and disorganized thought or altered level of consciousness -- Hallmark: acute onset and fluctuating clinical course Most often drug related (40%) - but all other organic causes must be ruled out
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
DSM-IV Diagnosis of Delirium A. Reduced ability to maintain and shift attention to external stimuli B. Disorganized thinking, as indicated by rambling, irrelevant, or incoherent speech C. At least two of the following:
Background image of page 10
Image of page 11
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

Page1 / 34

Acute_Mental_Status_Changes[1] 4.18.58 PM - Acute Mental...

This preview shows document pages 1 - 11. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online