Lights On Nobodys Home-Pediatric AMS

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Pediatric AMS Shore EMS Conference 2010

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  • The reticular activating system is the name given to the part of the brain (the reticular formation and its connections) believed to be the center of alert state , arousal and motivation in animals (including humans). In part responsible for the various rhythms of the body including circadian, heart, respiratory,
  • Lights On Nobodys Home-Pediatric AMS

    1. 1. Lights On Nobody’s Home Altered Mental Status
    2. 2. Overview <ul><li>Altered mental status is one of the most challenging situations EMS is called to manage </li></ul><ul><li>Mental status is a sensitive indication of perfusion and oxygenation to the brain </li></ul>
    3. 4. Physiology <ul><li>Consciousness is awareness of self and one’s surroundings </li></ul><ul><ul><li>Arousal </li></ul></ul><ul><ul><ul><li>Reticular activating system </li></ul></ul></ul><ul><ul><li>Cognition </li></ul></ul><ul><ul><ul><li>Frontal lobes </li></ul></ul></ul><ul><ul><ul><li>Higher processing </li></ul></ul></ul>
    4. 5. Physiology <ul><li>The human brain: (a) a superficial view of the brain; (b) components of the brainstem. </li></ul>
    5. 6. Physiology <ul><li>Altered mental status </li></ul><ul><ul><li>Any abnormal change in level of consciousness </li></ul></ul><ul><ul><ul><li>Arousal, orientation, cognitive ability </li></ul></ul></ul><ul><ul><ul><li>Bilateral cortical disease or suppression of the RAS </li></ul></ul></ul>
    6. 7. Common Etiologies <ul><li>Respiratory compromise </li></ul><ul><li>Trauma </li></ul><ul><li>Toxins </li></ul><ul><li>Hypoperfusion </li></ul><ul><li>Metabolic disorders </li></ul><ul><li>Non-traumatic structural lesions </li></ul>
    7. 8. Common Etiologies <ul><li>Toxic ingestions are often the cause of altered mental status in children. Either accidentally or deliberately, children may ingest prescribed or over-the-counter medications. </li></ul>
    8. 9. Etiologies <ul><li>Intracranial </li></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Structural or Mechanical malfunction </li></ul></ul><ul><ul><ul><li>Shunt or lesion </li></ul></ul></ul><ul><li>Extracranial </li></ul><ul><ul><li>Metabolic </li></ul></ul><ul><ul><li>Ingestion </li></ul></ul><ul><ul><li>Hepatic or Renal failure </li></ul></ul>
    9. 10. Etiologies <ul><li>A lcohol </li></ul><ul><li>E pilepsy </li></ul><ul><li>I nsulin </li></ul><ul><li>O verdose </li></ul><ul><li>U nusual metabolic disturbances </li></ul><ul><li>T rauma </li></ul><ul><li>I ntracranial Abnormalities </li></ul><ul><li>P oisoning </li></ul><ul><li>S epsis </li></ul>A-E-I-O-U-T-I-P-S
    10. 11. Assessment <ul><li>Airway </li></ul><ul><li>Breathing </li></ul>Vomit !
    11. 12. Assessment <ul><li>Breathing </li></ul><ul><ul><li>Watch out for respiratory depression </li></ul></ul><ul><ul><li>Always pay close attention to oxygenation </li></ul></ul>
    12. 13. Assessment <ul><li>Circulation </li></ul><ul><ul><li>Evaluate perfusion </li></ul></ul><ul><ul><ul><li>Early recognition of hypovolemia—especially dehydration </li></ul></ul></ul><ul><ul><li>Vascular access </li></ul></ul><ul><ul><ul><li>Provide fluids for dehydration </li></ul></ul></ul><ul><ul><ul><li>Assess glucose when obtaining access </li></ul></ul></ul>
    13. 14. Assessment <ul><li>Normal patient assessment </li></ul><ul><li>Assess and treat complications of AMS </li></ul><ul><ul><li>Airway </li></ul></ul><ul><ul><li>Breathing </li></ul></ul><ul><ul><li>Circulation </li></ul></ul><ul><li>Identify treatable </li></ul><ul><li>etiologies </li></ul><ul><ul><li>Oxygenation and </li></ul></ul><ul><ul><li>perfusion </li></ul></ul>
    14. 15. Assessment <ul><li>Mental status </li></ul><ul><ul><li>Level of consciousness and orientation </li></ul></ul><ul><ul><li>Appropriate for their age </li></ul></ul><ul><ul><li>and </li></ul></ul><ul><ul><li>stage of development? </li></ul></ul>
    15. 16. Assessment <ul><li>First impression </li></ul><ul><ul><li>Clues to the level of consciousness and degree of </li></ul></ul><ul><ul><li>alteration </li></ul></ul>
    16. 17. <ul><li>Decreased mental status? </li></ul>
    17. 18. <ul><li>All children with AMS are </li></ul><ul><li>CRITICAL UNTIL PROVEN OTHERWISE </li></ul>
    18. 19. Assessment <ul><li>Focused history </li></ul><ul><ul><li>Recent head trauma </li></ul></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Poisoning </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Intracranial abnormalities </li></ul></ul><ul><ul><li>Onset of symptoms (rapid or insidious) </li></ul></ul><ul><ul><li>Similar episodes in the past </li></ul></ul><ul><ul><li>Patient or family history of diabetes </li></ul></ul><ul><ul><li>Ingestion of medications or other potentially toxic substances </li></ul></ul>
    19. 20. Assessment <ul><li>Physical exam </li></ul>
    20. 21. Assessment
    21. 22. Assessment <ul><li>Triage and transport decisions </li></ul>
    22. 23. Further Treatments <ul><li>Consider </li></ul><ul><ul><li>Naloxone </li></ul></ul><ul><ul><li>Glucose/glucagon </li></ul></ul>
    23. 24. Summary <ul><li>Signs of AMS may be subtle in children </li></ul><ul><li>Remember Airway and Breathing ! </li></ul><ul><li>Treat complications first, then assess for etiology </li></ul>
    24. 25. Questions? Answers !!
    25. 26. Thank You For further information, please contact me: Bob Waddell II (307) 920 - 2020 [email_address]

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