Goals

• Trainee will demonstrate competence in the initial evaluation and basic management of patients with altered mental status

Objectives

Trainee will be able to:

• Define and describe the differences between delirium, dementia and psychosis

• Outline steps in the initial assessment to the patient with altered mental status

• Produce a differential diagnosis for altered mental status

• List rapidly reversible causes of altered mental status and appropriate interventions for each diagnosis

  • Alcohol withdrawal –> GABA agonists

  • Hypoglycemia –> Dextrose

  • Hypoxia –> Supplemental oxygen

  • Hypercarbia –> Ventilation

  • Hyper/hypothermia –> Cooling/warming measures

  • Hypertensive encephalopathy –> Antihypertensives

  • Opioid intoxication –> Naloxone

• Describe common exam findings and diagnostic studies used to determine the etiology of altered mental status

• Describe basic treatments for each disease category included in the differential diagnosis of altered mental status

• List and describe non-pharmacologic and pharmacologic strategies to treat patients at risk of harming themselves or others

Overview

• AMS (CDEM 2019)

• AMS (First 10 EM 2018)

• AMS Part 1 (EM:RAP 2016)

• AMS Part 2 (EM:RAP 2016)

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Alcohol Withdrawal

• Alcohol Withdrawal (emDocs 2016)

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Hypertensive Encephalopathy

• Hypertensive Encephalopathy (EM:RAP 2020)

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Opioid intoxication

• Opioids (ACEP Clinical Policy 2012) (pdf)

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Psychiatric Disease

• Psychiatric Patients (ACEP Clinical Policy 2017) (pdf)