Approach
• Broadly includes mild confusional states, delirium, dementia, & coma
• If unconscious or severely altered: ABCs, O2 for hypoxia & “coma cocktail”:
• Bedside glucose measurement or give 1 amp D50W
• Narcan 0.4–2 mg IV or IM, thiamine 100 mg
• Careful history: Underlying disorder, witness to onset, time of onset, circumstances surrounding AMS, meds, e/o intoxication/substance use
• Physical exam: Vitals, signs of trauma, focal neurologic sxs, pupil exam, skin exam
• Evaluation: CBC, Chem 10, LFTs, TSH, tox screen, ECG, UA, CXR, ±CO, NH3, head CT, LP
Delirium
Definition
• Acute state of temporary or fluctuating disturbance of consciousness (eg, impaired cognition, perception disturbances, reduced attention, hypo- or hyperactivity) that is caused by an organic medical condition or medication/drug (ie, not psychiatric)
• Progressive, unremitting decline in cognitive function is dementia
Pearl
• Organic etiology (as opposed to functional/psychiatric) is more likely if age <12 or >40, having visual hallucinations (as opposed to auditory), acute onset, or any abnl exam
Dementia
Definition
• Chronic steady decline in short- & eventual long-term memory
• Stuttering course may point to vascular (multi-infarct) dementia due to lacunar infarcts
