Altered Mental Status Medical Slides

Present each category with key diagnoses: A (Alcohol, Acidosis), E (Epilepsy, Electrolytes, Encephalopathy), I (Infection — meningitis, encephalitis, sepsis, UTI in elderly), O (Overdose/toxins — screen for toxidromes), U (Uremia and metabolic). T (Trauma, Temperature — hypo/hyperthermia), I (Insulin — hypo/hyperglycemia), P (Psychiatric, Porphyria), S (Stroke, Space-occupying lesion, Subarachnoid hemorrhage). Emphasize that multiple etiologies commonly coexist — the intoxicated patient may also have a subdural hematoma, and the elderly UTI patient may also be hypoglycemic.

Present the "coma cocktail" and initial interventions: (1) Finger-stick glucose — treat hypoglycemia with D50 25 g IV (most common reversible cause). (2) Naloxone 0.4-2 mg IV/IM/IN if opioid toxidrome suspected (miosis, respiratory depression). (3) Thiamine 100 mg IV BEFORE glucose in suspected alcoholism/malnutrition (prevent Wernicke precipiation). (4) Check temperature — hypothermia and hyperthermia are both causes and consequences of AMS. (5) Head CT without contrast if any trauma, focal deficit, papilledema, or anticoagulation. (6) LP if meningitis/encephalitis suspected — do not delay antibiotics for imaging.

Present the five classic toxidromes with exam findings: Sympathomimetic (cocaine, methamphetamine) — hypertension, tachycardia, mydriasis, hyperthermia, agitation. Anticholinergic (diphenhydramine, TCAs) — "dry as a bone, blind as a bat, red as a beet, mad as a hatter" — tachycardia, mydriasis, dry skin, urinary retention, absent bowel sounds. Opioid — miosis, respiratory depression, bradycardia, hypothermia. Serotonin syndrome — clonus, hyperreflexia, hyperthermia, agitation (distinguised from NMS by clonus and hyperreflexia). Cholinergic (organophosphates) — DUMBELS (diarrhea, urination, miosis, bronchospasm, emesis, lacrimation, salivation). Each toxidrome points to specific antidotes.