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By Dr. Nauman Zafer PGR Medicine
 Vague but commonly used term that is
applied to both alteration in level of
consciousness and alteration in cognitive
function
 Quick assessment is made using AVPU scale
or Glasgow coma scale (GCS)
 Detailed evaluation may require mini–mental
state examination (MMSE)
A
The patient is alert
V
The patient responds
to verbal stimulation
P
The patient responds
to painful stimulation
U
The patient is
completely
unresponsive
Best eye response (E) Best verbal response
(V)
Best motor resposnse
(M)
4 Eyes opening
spontaneously
5 Oriented 6 Obeys commands
3 Eyes opening to
speech
4 Confused 5 Localizes to pain
2 Eye opening in
response to pain
3 Inappropriate words 4Withdraws from pain
1 No eye opening 2 Incomprehensible
sounds
3 Flexion in response to
pain
1 None 2 Extension in response
to pain
1 No motor response
 30-point questionnaire
 It is used to measure cognitive impairment
 Serial measurements can document further
decline in cognition or response to treatment
 Drugs and drug withdrawal
 Sedatives (Benzodiazepines, Opioids,
Alcohol)
 Withdrawal of sedating drugs (e.g. delirium
tremens due to alcohol withdrawal)
 Infections
 CNS infections (Meningitis, Encephalitis,
Brain abscess)
 Others (UTI, RTI, Sepsis)
 Metabolic and Electrolytes
 Metabolic
Hypo/hyperglycemia,Acidosis, Liver disease,
Kidney disease,Addison disease,
Thyrotoxicosis, Myxedema coma
 Electrolyte Disturbances
Hyper/hyponatremia, Hypercalcemia,
Hyper/hypomagnesemia, Hypophosphatemia
 Tumor
 CNS tumors
 Trauma
 Concussion, Contusion
 Vascular
 Systemic (Hypertension, Hypotension,
Shock)
 Local (CVA,Vasculitis)
 Others
 Defeciencies of vitamins (B12, Niacin,
Thiamin)
 Environmental (Hyper/hypothermia)
 Acute CO2 retention
 Toxins (Organophosphates, CO)
 Hypoxemia
 Emergency department management, initial
resuscitation
 Detailed history, examination, investigations
 General Nursing care
CABG
C circulation
A airway
B breathing
G glucose
 Should be performed parallel with or after
initial resuscitation
 Complete history, GPE and complete
systemic examination for cause and
complications
 CBC
 LFTs, RFTs
 Na, Ca, Mg, PO4
 ESR, CRP
 ABGs
 ECG
 Urine C/E
 CXR
 CT scan brain
 USG abdomen, pelvis, KUB
Additional as required
 MRI brain
 Peripheral blood picture
 B12 levels
 Urine C/S
 EEG
 TFTs
 AFB smear, C/S, Xpert MTB/RIF on body fluids
Hydration
Nutrition
Physiotherapy
General hygiene and skin care
Bowel and Bladder care
Oral hygiene
Grooming
DVT prophylaxis
Bed sores prevention
Chest physiotherapy, Postural drainage,
Suction
Care of catheter sites
 Treatment of cause
 Treatment of complications
Ams
Ams

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Ams

  • 1. By Dr. Nauman Zafer PGR Medicine
  • 2.  Vague but commonly used term that is applied to both alteration in level of consciousness and alteration in cognitive function  Quick assessment is made using AVPU scale or Glasgow coma scale (GCS)  Detailed evaluation may require mini–mental state examination (MMSE)
  • 3. A The patient is alert V The patient responds to verbal stimulation P The patient responds to painful stimulation U The patient is completely unresponsive
  • 4. Best eye response (E) Best verbal response (V) Best motor resposnse (M) 4 Eyes opening spontaneously 5 Oriented 6 Obeys commands 3 Eyes opening to speech 4 Confused 5 Localizes to pain 2 Eye opening in response to pain 3 Inappropriate words 4Withdraws from pain 1 No eye opening 2 Incomprehensible sounds 3 Flexion in response to pain 1 None 2 Extension in response to pain 1 No motor response
  • 5.  30-point questionnaire  It is used to measure cognitive impairment  Serial measurements can document further decline in cognition or response to treatment
  • 6.  Drugs and drug withdrawal  Sedatives (Benzodiazepines, Opioids, Alcohol)  Withdrawal of sedating drugs (e.g. delirium tremens due to alcohol withdrawal)  Infections  CNS infections (Meningitis, Encephalitis, Brain abscess)  Others (UTI, RTI, Sepsis)
  • 7.  Metabolic and Electrolytes  Metabolic Hypo/hyperglycemia,Acidosis, Liver disease, Kidney disease,Addison disease, Thyrotoxicosis, Myxedema coma  Electrolyte Disturbances Hyper/hyponatremia, Hypercalcemia, Hyper/hypomagnesemia, Hypophosphatemia
  • 8.  Tumor  CNS tumors  Trauma  Concussion, Contusion  Vascular  Systemic (Hypertension, Hypotension, Shock)  Local (CVA,Vasculitis)
  • 9.  Others  Defeciencies of vitamins (B12, Niacin, Thiamin)  Environmental (Hyper/hypothermia)  Acute CO2 retention  Toxins (Organophosphates, CO)  Hypoxemia
  • 10.  Emergency department management, initial resuscitation  Detailed history, examination, investigations  General Nursing care
  • 11. CABG C circulation A airway B breathing G glucose
  • 12.  Should be performed parallel with or after initial resuscitation  Complete history, GPE and complete systemic examination for cause and complications
  • 13.  CBC  LFTs, RFTs  Na, Ca, Mg, PO4  ESR, CRP  ABGs  ECG  Urine C/E
  • 14.  CXR  CT scan brain  USG abdomen, pelvis, KUB
  • 15. Additional as required  MRI brain  Peripheral blood picture  B12 levels  Urine C/S  EEG  TFTs  AFB smear, C/S, Xpert MTB/RIF on body fluids
  • 16. Hydration Nutrition Physiotherapy General hygiene and skin care Bowel and Bladder care Oral hygiene Grooming
  • 17. DVT prophylaxis Bed sores prevention Chest physiotherapy, Postural drainage, Suction Care of catheter sites
  • 18.  Treatment of cause  Treatment of complications