ALTERED MENTAL STATUS MAJA PRLE Mentor A mega

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ALTERED MENTAL STATUS MAJA PRŠLE Mentor: A. Žmegač Horvat

ALTERED MENTAL STATUS MAJA PRŠLE Mentor: A. Žmegač Horvat

ALTERED MENTAL STATUS • INDICATIVE OF: central nervous system (CNS) injury or illness •

ALTERED MENTAL STATUS • INDICATIVE OF: central nervous system (CNS) injury or illness • Mental status : clinical state of emotional and intellectual functioning of the individual

What is consciousness? • Arousal function – – alertness and wakefulness anatomically reticular activating

What is consciousness? • Arousal function – – alertness and wakefulness anatomically reticular activating system • Content functions – – language, reasoning anatomically cerebral cortex

Disruptions of consciousness • Arousal functions (and/or) • Content functions disrupted

Disruptions of consciousness • Arousal functions (and/or) • Content functions disrupted

Altered mental status • may present as: mild confusion complete unconsciousness (coma) Methods of

Altered mental status • may present as: mild confusion complete unconsciousness (coma) Methods of evaluation: Glasgow Coma Scale or AVPU (best eye, verbal and motor response) (Alert, Verbal stimuli, Painful stimuli, Unresponsive) or MINI MENTAL state examination (qualitative method for assessing cognitive impairment)

EXAMPLES • ACUTE CONFUSIONAL STATE • ACUTE COGNITIVE IMPAIRMENT • DELIRIUM (acute encephalopathy) •

EXAMPLES • ACUTE CONFUSIONAL STATE • ACUTE COGNITIVE IMPAIRMENT • DELIRIUM (acute encephalopathy) • COMA

“SMASHED”- mnemonic for acute mental status change S Substrates Sepsis ( hyperglycemia, hypoglycemia, thiamine

“SMASHED”- mnemonic for acute mental status change S Substrates Sepsis ( hyperglycemia, hypoglycemia, thiamine ) M Meningitis Mental illness ( meningitis and other CNS infections ) ( functional psychoses ) A Alcohol ( intoxication, withdrawal ) S Seizures Stimulants ( seizure activity, post-ictal states ) ( anticholinergics, hallucinogens, cocaine ) H Hyper Hypo ( hyperthyroidism, hyperthermia, hypercarbia ) ( hypotension, hypothyroidism, hypoxia, hypothermia ) E Electrolytes Encephalopathy ( hypernatremia, hyponatremia, hypercalcemia ) ( hepatic, uremic, hypertensive ) D Drugs of any sort

DELIRIUM • reduced level of consciousness • perceptual disturbances: misinterpretations, illusions or hallucinations •

DELIRIUM • reduced level of consciousness • perceptual disturbances: misinterpretations, illusions or hallucinations • disturbance of wake-sleep cycle • increased OR decreased psychomotor activity • disorientation to time, place, or person • memory impairment

DELIRIUM • 4 general causes 1. primary intracranial disease 2. systemic disease affecting CNS

DELIRIUM • 4 general causes 1. primary intracranial disease 2. systemic disease affecting CNS 3. exogenous toxins 4. drug withdrawal TREAT THE UNDERLYING CAUSE! + PROVIDE ALS IF NEEDED

COMA • state of reduced alertness and responsiveness from which you cannot be aroused

COMA • state of reduced alertness and responsiveness from which you cannot be aroused • Glasgow Coma Scale – SCORE 3 -15 COMA SCORE IS 3 -8 • (best EYE, VERBAL and MOTOR response)