SHM's Clinical Quick Talks-Approach to Acute Altered Mental Status

Pdf Summary

The document, "Altered Mental Status" by David Klimpl, provides a structured approach for teaching hospital medicine learners about altered mental status (AMS). It emphasizes a stepwise methodology to diagnose and manage AMS effectively.<br /><br />Key teaching strategies include:<br />1. **Urgency Assessment**: Prioritize stabilizing emergent conditions. This involves taking a full set of vitals, conducting a primary survey, and administering naloxone if necessary. Immediate support should be sought for patients with an unstable airway or other critical conditions.<br /><br />2. **General Data Gathering**: Initial data collection is crucial to formulating a differential diagnosis (DDX). Important questions include the patient's last known normal condition and any inciting factors. Reviewing recent interventions and centrally acting medications is also essential.<br /><br />3. **Focused Data Gathering and STAT Interventions**: This involves evaluating alertness levels, noting any focal deficits or seizure-like activity, and obtaining critical tests like point-of-care testing (POCT) for glucose, bladder scans, and other relevant labs based on clinical presentation. Immediate interventions may include paging neurology for new focal deficits, administering benzodiazepines for seizures, and initiating broad-spectrum antibiotics for suspected infections.<br /><br />Clinical scenarios are divided into those with acute unresponsiveness (considering intracranial hemorrhage, drug effects, infections, etc.) and those with acute agitation (considering infections, withdrawal, and polypharmacy). The approach encourages using differential signs like asterixis for hepatic encephalopathy and monitoring risk factors for hypercapnia.<br /><br />Clinical pearls stress managing acute AMS changes in person and prompt identification of common and critical conditions like delirium, toxic encephalopathy, and seizures. A basic workup often includes tests like CBC, CMP, and CT scans.<br /><br />The teaching script is designed for educational situations, including admissions and medication adjustments in high-risk populations. Resources such as conventional review articles and video clips with diagnostic schemas are suggested for further learning.

Asset Subtitle

Joseph R. Bell, Alexandra C. Collis, Vince Raikhel, David Carlbom

Keywords

Altered Mental Status

David Klimpl

hospital medicine

diagnosis

management

urgency assessment

differential diagnosis

clinical scenarios

educational resources

medical interventions