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Altered Mental Status Assessment: A Critical Evaluation and its Industry Implications
By Dr. Evelyn Reed, MD, FACP
_Dr. Evelyn Reed is a board-certified neurologist with over 15 years of experience in emergency medicine and critical care. She has published extensively on neurological assessment and is a frequent speaker at national medical conferences._
Published by: _The Journal of Emergency Medicine and Critical Care_ – A leading peer-reviewed journal dedicated to advancing the knowledge and practice of emergency medicine and critical care, trusted for its rigorous editorial process and high-impact publications for over 20 years.
Editor: _Dr. Michael Chen, MD, FACEP_ – _Dr. Chen is a seasoned emergency medicine physician with expertise in trauma and critical care. He has served as editor for numerous medical journals and has extensive experience in reviewing and editing medical manuscripts._
Abstract: This article provides a comprehensive overview of altered mental status (AMS) assessment, detailing its crucial role in emergency medicine and other healthcare settings. We will explore the various methods used for AMS assessment, highlighting their strengths and weaknesses. Furthermore, we will delve into the far-reaching implications of accurate and timely altered mental status assessment for patient outcomes, healthcare resource allocation, and the overall effectiveness of healthcare systems.
1. Introduction: The Significance of Altered Mental Status Assessment
Altered mental status (AMS) encompasses a wide spectrum of neurological conditions characterized by a deviation from a patient's baseline level of consciousness, cognition, or behavior. Prompt and accurate altered mental status assessment is paramount in emergency medicine, critical care, and even primary care settings. The early identification of the underlying cause of AMS can be life-saving, influencing treatment decisions and significantly impacting patient prognosis. Failure to promptly and accurately perform an altered mental status assessment can lead to delayed diagnosis, inappropriate treatment, and potentially adverse outcomes, including mortality.
2. The Components of a Comprehensive Altered Mental Status Assessment
A thorough altered mental status assessment requires a systematic approach encompassing several key components:
History: Obtaining a detailed patient history, including current medications, recent illnesses, known medical conditions, and any witnessed events leading to the AMS, is crucial. Information from family or bystanders can be invaluable.
Mental Status Examination: This involves assessing the patient's level of consciousness (using the Glasgow Coma Scale, for instance), orientation to person, place, and time, attention span, memory, language skills, and judgment.
Neurological Examination: A focused neurological exam assesses cranial nerves, motor strength, reflexes, and sensory function to detect focal neurological deficits that might indicate the underlying cause of the AMS.
Vital Signs: Monitoring vital signs, including heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation, is essential as they can provide clues to the underlying pathology.
Laboratory Investigations: Blood tests, including complete blood count (CBC), blood glucose, electrolyte levels, toxicology screen, and arterial blood gas (ABG) analysis, are frequently ordered to identify potential causes of AMS.
Imaging Studies: Neuroimaging techniques like computed tomography (CT) scans and magnetic resonance imaging (MRI) may be necessary to visualize intracranial structures and identify abnormalities such as intracranial hemorrhage, tumors, or infarcts.
3. Differential Diagnosis in Altered Mental Status Assessment
The differential diagnosis in AMS is extensive, ranging from relatively benign conditions to life-threatening emergencies. Potential causes include:
Metabolic Disorders: Hypoglycemia, hyperglycemia, electrolyte imbalances, hepatic encephalopathy, and uremia.
Infections: Meningitis, encephalitis, sepsis.
Neurological Disorders: Stroke, seizure, brain tumor, traumatic brain injury.
Toxicological Causes: Drug overdose, alcohol intoxication, poisoning.
Psychiatric Conditions: Delirium, depression, psychosis.
4. The Implications of Altered Mental Status Assessment for the Healthcare Industry
The accuracy and timeliness of altered mental status assessment have significant implications for various aspects of the healthcare industry:
Improved Patient Outcomes: Early diagnosis and appropriate treatment directly translate to better patient outcomes, reducing morbidity and mortality.
Efficient Resource Allocation: Accurate assessment helps prioritize patients, ensuring that those with the most urgent needs receive timely intervention, optimizing the use of healthcare resources.
Reduced Healthcare Costs: Avoiding delays in diagnosis and treatment can significantly reduce the overall cost of care by preventing complications and prolonged hospital stays.
Enhanced Healthcare Quality: Improving the consistency and accuracy of altered mental status assessment contributes to higher standards of healthcare quality and patient safety.
Legal and Ethical Considerations: Proper documentation of the altered mental status assessment is crucial for legal and ethical reasons, protecting both the patient and healthcare providers.
5. Advancements in Altered Mental Status Assessment
Technological advancements continue to refine and improve the process of altered mental status assessment. These include:
Point-of-care testing: Rapid diagnostic tests for blood glucose, blood gases, and other critical parameters are improving the speed and efficiency of assessment.
Advanced neuroimaging techniques: Higher-resolution imaging technologies provide more detailed information about intracranial structures, aiding in diagnosis.
Artificial intelligence (AI): AI-powered tools are being developed to assist in the interpretation of clinical data and improve the accuracy of diagnosis.
6. Conclusion
Altered mental status assessment is a critical skill for all healthcare professionals. A systematic approach, combining a detailed history, thorough physical examination, and appropriate laboratory and imaging studies, is crucial for accurately identifying the underlying cause of AMS. Improving the accuracy and timeliness of altered mental status assessment will continue to have a profound impact on patient outcomes, resource allocation, and the overall quality of healthcare. Ongoing research and technological advancements will undoubtedly further enhance our ability to diagnose and manage this complex clinical presentation.
Frequently Asked Questions (FAQs)
1. What is the difference between delirium and dementia? Delirium is an acute, fluctuating change in mental status, while dementia is a chronic, progressive decline in cognitive function.
2. What is the Glasgow Coma Scale (GCS)? The GCS is a standardized tool used to assess the level of consciousness in patients with suspected brain injury.
3. Can altered mental status be a symptom of a stroke? Yes, altered mental status is a common symptom of stroke, particularly ischemic strokes affecting the brainstem or dominant hemisphere.
4. What are the key components of a neurological examination in AMS assessment? Cranial nerve examination, motor strength assessment, deep tendon reflex testing, and assessment of sensory function.
5. What imaging studies are commonly used in AMS assessment? CT scans and MRIs are most commonly used to visualize the brain and detect abnormalities.
6. How is hypoglycemia related to altered mental status? Low blood sugar can deprive the brain of energy, leading to confusion, lethargy, and even coma.
7. What are the ethical considerations in assessing patients with AMS? Ensuring informed consent, respecting patient autonomy, and protecting patient confidentiality are vital ethical considerations.
8. What is the role of toxicology testing in AMS assessment? Toxicology testing helps detect the presence of drugs, alcohol, or other toxins that may be contributing to the AMS.
9. How can healthcare systems improve their approach to AMS assessment? Implementing standardized protocols, providing continuing education for healthcare providers, and utilizing advanced technologies can enhance the quality of AMS assessment.
Related Articles:
1. "The Glasgow Coma Scale: A Comprehensive Guide": A detailed explanation of the GCS and its application in clinical practice.
2. "Differential Diagnosis of Altered Mental Status in the Elderly": A focused review of AMS causes specific to the older adult population.
3. "Neuroimaging in the Evaluation of Altered Mental Status": An in-depth discussion of the role of CT scans and MRIs in diagnosing AMS.
4. "The Impact of Rapid Diagnostic Testing on Altered Mental Status Management": An analysis of the benefits of point-of-care testing in improving the efficiency of AMS assessment.
5. "Altered Mental Status in Pediatric Patients: A Practical Approach": A guide to assessing and managing AMS in children.
6. "The Role of Artificial Intelligence in Altered Mental Status Diagnosis": Exploring the potential of AI in improving the accuracy and speed of AMS diagnosis.
7. "Ethical Considerations in the Management of Patients with Altered Mental Status": A discussion of the ethical dilemmas encountered in managing patients with AMS.
8. "Cost-Effectiveness of Different Strategies for Altered Mental Status Assessment": An economic evaluation comparing different approaches to AMS assessment.
9. "Improving the Quality of Altered Mental Status Assessment Through Standardized Protocols": A review of how standardized protocols can enhance the consistency and accuracy of AMS assessment.
| altered mental status assessment: An Introduction to Clinical Emergency Medicine S. V. Mahadevan, Gus M. Garmel, 2012-04-10 Fully-updated edition of this award-winning textbook, arranged by presenting complaints with full-color images throughout. For students, residents, and emergency physicians. |
| altered mental status assessment: Chalk Talks in Internal Medicine Somnath Mookherjee, Lauren A. Beste, Jared W. Klein, Jennifer Wright, 2020-09-30 This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Every year, thousands of attending internists are asked to train the next generation of physicians to master a growing body of knowledge. Formal teaching time has become increasingly limited due to rising clinical workload, medical documentation requirements, duty hour restrictions, and other time pressures. In addition, today’s physicians-in-training expect teaching sessions that deliver focused, evidence-based content that is integrated into clinical workflow. In keeping with both time pressures and trainee expectations, academic internists must be prepared to effectively and efficiently teach important diagnostic and management concepts. A teaching script is a methodical and structured plan that aids in effective teaching. The teaching scripts in this book anticipate learners’ misconceptions, highlight a limited number of teaching points, provide evidence to support the teaching points, use strategies to engage the learners, and provide a cognitive scaffold for teaching the topic that the teacher can refine over time. All divisions of internal medicine (e.g. cardiology, rheumatology, and gastroenterology) are covered and a section on undifferentiated symptom-based presentations (e.g. fatigue, fever, and unintentional weight loss) is included. This book provides well-constructed teaching scripts for commonly encountered clinical scenarios, is authored by experienced academic internists and allows the reader to either implement them directly or modify them for their own use. Each teaching script is designed to be taught in 10-15 minutes, but can be easily adjusted by the reader for longer or shorter talks. Teaching Scripts in Internal Medicine is an ideal tool for internal medicine attending physicians and trainees, as well as physician’s assistants, nurse practitioners, and all others who teach and learn internal medicine. |
| altered mental status assessment: The Saint-Chopra Guide to Inpatient Medicine Sanjay Saint, Vineet Chopra, 2018 Preceded by: Clinical clerkship in inpatient medicine / Sanjay Saint. 3rd ed. c2010. |
| altered mental status assessment: Emergency Medical Services Jane H. Brice, Theodore R. Delbridge, J. Brent Myers, 2021-08-12 The two-volume Emergency Medical Services: Clinical Practice and Systems Oversight delivers a thorough foundation upon which to succeed as an EMS medical director and prepare for the NAEMSP National EMS Medical Directors Course and Practicum. Focusing on EMS in the 'real world', the book offers specific management tools that will be useful in the reader's own local EMS system and provides contextual understanding of how EMS functions within the broader emergency care system at a state, local, and national level. The two volumes offer the core knowledge trainees will need to successfully complete their training and begin their career as EMS physicians, regardless of the EMS systems in use in their areas. A companion website rounds out the book's offerings with audio and video clips of EMS best practice in action. Readers will also benefit from the inclusion of: A thorough introduction to the history of EMS An exploration of EMS airway management, including procedures and challenges, as well as how to manage ventilation, oxygenation, and breathing in patients, including cases of respiratory distress Practical discussions of medical problems, including the challenges posed by the undifferentiated patient, altered mental status, cardiac arrest and dysrhythmias, seizures, stroke, and allergic reactions An examination of EMS systems, structure, and leadership |
| altered mental status assessment: Prehospital Care of Neurologic Emergencies Todd Crocco, Michael Sayre, 2014-07-24 Prehospital Care of Neurologic Emergencies is a reliable and definitive resource for emergency medical services personnel at multiple levels: physicians, paramedics, nurses and others who encounter these critically ill patients. This focused and succinct book addresses the management of a wide range of neurologic emergencies, including traumatic brain injuries, spinal cord injuries, strokes, and seizures. In these emergencies time is critical, and the simply presented, straightforward format of the patient care and management recommendations help readers to treat patients rapidly and confidently. Each chapter follows a standard format that includes an overview of each neurologic emergency, important background, key challenges, and areas requiring future investigation. This book is unlikely to be placed on your bookshelf; instead, you will keep it nearby for times when you face life-threatening neurologic emergencies. When seconds count, this book has the answers. |
| altered mental status assessment: Symptom-Based Diagnosis in Pediatrics (CHOP Morning Report) Samir S. Shah, Stephen Ludwig, 2014-01-03 A CASE-BASED GUIDE TO PEDIATRIC DIAGNOSIS, CONVENIENTLY ORGANIZED BY PRESENTING SYMPTOMS Symptom-Based Diagnosis in Pediatrics features 19 chapters, each devoted to a common pediatric complaint. Within each chapter, five to eight case presentations teach the diagnostic approach to the symptom. The case presentations follow a consistent outline of History, Physical Examination, and Course of Illness, and are followed by discussion of the Differential Diagnosis, Diagnosis Incidence and Epidemiology, Clinical Manifestations, Diagnostic Approach, and Treatment. Cases are illustrated with vibrant full-color photographs and include numerous tables comparing potential diagnoses. Organized by symptoms--the way patients actually present More than 100 cases teach the diagnostic approach to a symptom Cases illustrate how the same complaint can have a variety of causes Full-color clinical photos and illustrations sharpen your visual diagnosis skills Valuable tables detail the most frequent causes of common symptoms CASE-BASED COVERAGE OF THE SYMPTOMS YOU'RE MOST LIKELY TO ENCOUNTER IN PEDIATRIC PRACTICE Wheezing * Decreased Activity Level * Vomiting * Coughing * Back, Joint, and Extremity Pain * Poor Weight Gain * Abdominal Pain * Altered Mental Status * Rash * Pallor * Fever * Constipation * Neck Swelling * Chest Pain * Jaundice * Abnormal Gait * Diarrhea * Syncope * Seizures Editors Samir S. Shah, MD, MSCE is Director, Division of Hospital Medicine, James M. Ewell Endowed Chair, and Attending Physician in Hospital Medicine & Infectious Diseases at Cincinnati Children’s Hospital Medical Center; and Professor in the Department of Pediatrics at the University of Cincinnati College of Medicine. Stephen Ludwig, MD is Chairman of the Graduate Medical Education Committee and Continuing Medical Education Committee and an attending physician in general pediatrics at The Children's Hospital of Philadelphia; and Emeritus Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. |
| altered mental status assessment: Fragility Fracture Nursing Karen Hertz, Julie Santy-Tomlinson, 2018-06-15 This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care. |
| altered mental status assessment: Basic Emergency Care: Approach to the Acutely Ill and Injured World Health Organization, 2018-12-17 Developed by WHO and the International Committee of the Red Cross, in collaboration with the International Federation for Emergency Medicine, Basic Emergency Care (BEC): Approach to the acutely ill and injured is an open-access training course for frontline healthcare providers who manage acute illness and injury with limited resources.BEC teaches a systematic approach to the initial assessment and management of time-sensitive conditions where early intervention saves lives. It includes modules on: the ABCDE and SAMPLE history approach, trauma, difficulty in breathing, shock, and altered mental status. The practical skills section covers the essential time-sensitive interventions for these key acute presentations.The BEC package includes a Participant Workbook and electronic slide decks for each module. BEC integrates the guidance from WHO Emergency Triage, Assessment and Treatment (ETAT) for children, WHO Pocket Book of Hospital Care for Children, WHO Integrated Management of Pregnancy and Childbirth and the Integrated Management of Adult/Adolescent Illness (IMAI). |
| altered mental status assessment: EM Fundamentals Laura Welsh, 2021-06 This pocket-size reference manual includes quick guides, can't-miss diagnoses, warning signs, and common treatments for a host of conditions you'll encounter in the emergency department. Before you step into the exam area, look up a condition to get a differential, evaluation tips, management guidance, and disposition recommendations. The book is best for those who are covering shifts in the emergency department or at community sites. |
| altered mental status assessment: The Merck Veterinary Manual Merck and Co., Inc. Staff, 2003-11 For more than forty years, animal health professionals have turned to the Merck Veterinary Manualfor integrated, concise and reliable veterinary information. Now this manual covering the diagnosis, treatment, and prevention of diseases of companion, food and zoo animals.is available on an easy-to-use, fully searchable CD-ROM. The CD includes the full text of The Merck Veterinary Manual 8/e and has been enhanced with picture links featuring original anatomical artwork and numerous clinical and diagnostic illustrations, table links and quick search links that provide quick accesss to cross referenced text. |
| altered mental status assessment: Clinical Emergency Medicine Scott C. Sherman, Joseph W. Weber, Michael Schindlbeck, Rahul Patwari, 2014-01-10 Ninety-eight of the chief complaints and disorders you're most likely to encounter in the ED! A clear, concise guide for clinicians new to the Emergency Department A Doody's Core Title for 2015! Written by authors who are practicing emergency physicians and emergency medicine educators, Clinical Emergency Medicine distills the entire content of the emergency medicine curriculum into less than one hundred succinct, clinically relevant chapters. This unique book is intended to guide you through what you must know and be able to do during an actual shift and give you a better understanding of the issues and problems you will face while working in the Emergency Department. Featuring a consistent, find-it-now design, Clinical Emergency Medicine delivers concise, must-know information on ninety-eight chief complaints and disorders, ranging from asthma and chest pain to fever and poisoning. Each chapter begins with Key Points, followed by an Introduction, Clinical Presentation (History and Physical Examination), Diagnostic Studies, Medical Decision Making, Treatment and Disposition, and Suggested Reading. Whenever possible, the authors provide practical advice on drug dosing, the medical decision-making thought process, treatment plans, and dispositions that will be of value in a clinical environment. Numerous diagnostic algorithms simplify the problem and point you towards a solution. Valuable to medical students, physician assistants, nurse practitioners, and junior level residents, Clinical Emergency Medicine teaches you things that may not have been covered in medical or physician assistant school, but have an important bearing on patient outcomes. |
| altered mental status assessment: Clinical Pathways in Emergency Medicine Suresh S David, 2016-05-23 This book aims to provide condensed and crystallised knowledge, providing the rationale for investigations and interventions. Emergency medicine is a specialty where time and knowledge are critical factors in deciding appropriate management which could otherwise result in loss of life or limb. The challenge often is to have lucid management plans, whilst standing at the bedside of the patient. In order to address this challenge, a manuscript is needed which aims to enhance the clinical skills of the emergency physician. The objective of this book is to compile a road map for practitioners of emergency medicine, which would guide them through algorithm-based pathways. This format is distinctive by nature for its concise presentation, which facilitates easy reading and early application. Written by global experts, this book aims to be a truly international representation of emergency physicians who have come together to deliver contemporary concepts in emergency patient care. |
| altered mental status assessment: The Social Determinants of Mental Health Michael T. Compton, Ruth S. Shim, 2015-04-01 The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the take-away messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a Call to Action, offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health. |
| altered mental status assessment: Neurologic Emergencies Latha Ganti, Joshua N. Goldstein, 2018-01-22 This book is an unparalleled resource on neurologic emergencies. Most books on neurologic emergencies focus on treatment of a disease after it is diagnosed (such as stroke, subarachnoid hemorrhage, or meningitis). There are but a few books that focus on how to evaluate the patient with a neurologic symptom, before the diagnosis is made. This is the area that frontline providers, including emergency physicians, family physicians, primary care physicians, hospitalists, urgent care physicians, and midlevel providers struggle with. This book is written by clinicians with a clear understanding of the needs of non-neurologists in the front lines of medicine. The editors are board-certified emergency physicians with fellowship training and expertise in neurologic emergencies. Neurologic Emergencies includes these point-of-care-friendly features: Extensive number of algorithms for distinct presenting symptoms Classic neuroimaging findings A concise bullet on what information needs to be conveyed to consultants Reference to relevant national guidelines where applicable Common chapter format to facilitate quick look-up |
| altered mental status assessment: Diagnostic Interviewing Daniel L. Segal, Michel Hersen, 2009-12-15 This volume represents a clear, jargon-free overview of diagnostic categories with helpful hints regarding a psychiatric interview. Completely revised and updated, detailing current innovations in theory and practice, including recent changes in the DSM-IV. |
| altered mental status assessment: Diagnostic Imaging for the Emergency Physician E-Book Joshua S. Broder, 2011-03-15 Diagnostic Imaging for the Emergency Physician, written and edited by a practicing emergency physician for emergency physicians, takes a step-by-step approach to the selection and interpretation of commonly ordered diagnostic imaging tests. Dr. Joshua Broder presents validated clinical decision rules, describes time-efficient approaches for the emergency physician to identify critical radiographic findings that impact clinical management and discusses hot topics such as radiation risks, oral and IV contrast in abdominal CT, MRI versus CT for occult hip injury, and more. Diagnostic Imaging for the Emergency Physician has been awarded a 2011 PROSE Award for Excellence for the best new publication in Clinical Medicine. - Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. - Choose the best test for each indication through clear explanations of the how and why behind emergency imaging. - Interpret head, spine, chest, and abdominal CT images using a detailed and efficient approach to time-sensitive emergency findings. - Stay on top of current developments in the field, including evidence-based analysis of tough controversies - such as indications for oral and IV contrast in abdominal CT and MRI versus CT for occult hip injury; high-risk pathology that can be missed by routine diagnostic imaging - including subarachnoid hemorrhage, bowel injury, mesenteric ischemia, and scaphoid fractures; radiation risks of diagnostic imaging - with practical summaries balancing the need for emergency diagnosis against long-terms risks; and more. - Optimize diagnosis through evidence-based guidelines that assist you in discussions with radiologists, coverage of the limits of negative or normal imaging studies for safe discharge, indications for contrast, and validated clinical decision rules that allow reduced use of diagnostic imaging. - Clearly recognize findings and anatomy on radiographs for all major diagnostic modalities used in emergency medicine from more than 1000 images. - Find information quickly and easily with streamlined content specific to emergency medicine written and edited by an emergency physician and organized by body system. |
| altered mental status assessment: Synopsis of Pediatric Emergency Medicine Gary Robert Fleisher, Stephen Ludwig, Benjamin K. Silverman, 2002 This handbook is a condensed, portable, rapid-reference version of Fleisher and Ludwig's Textbook of Pediatric Emergency Medicine, Fourth Edition, one of the most widely respected books in the field. In a format designed for quick bedside consultation, the Synopsis presents the most essential clinical information from the Textbook's chapters on life-threatening emergencies, signs and symptoms, medical emergencies, trauma, surgical emergencies, and psychosocial emergencies. Each Synopsis chapter covers evaluation, differential diagnosis, physical examination, and management. The 66 signs and symptoms are in alphabetical order and medical emergencies, surgical emergencies, and trauma are organized by body system. |
| altered mental status assessment: Model Rules of Professional Conduct American Bar Association. House of Delegates, Center for Professional Responsibility (American Bar Association), 2007 The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts. |
| altered mental status assessment: En Route Steven Kelly Grayson, 2016-12-02 Steven Kelly Grayson has seen the best of us at our worst. When hearts stop working, when blood alcohol levels exceed limits we shouldn't contemplate, when bodies are extricated from car wrecks, he's been there to pick up the pieces, save our lives, and watch us slip away. En Route is an unflinching look at the heart of a paramedic and the profession that shaped him. Grayson's touching stories of life and death and the hilarious ones of times in between are here to give us an insight of what happens after we call 911, the ambulance doors close, or even what happens inside the ER when the nurse shows the family to the waiting room. |
| altered mental status assessment: The Comatose Patient Eelco F.M. Wijdicks, 2014-04-28 The Comatose Patient, Second Edition, is a critical historical overview of the concepts of consciousness and unconsciousness, covering all aspects of coma within 100 detailed case vignettes. This comprehensive text includes principles of neurologic examination of comatose patients as well as instruction of the FOUR Score coma scale, and also discusses landmark legal cases and ethical problems. As the Chair of Division of Critical Care Neurology at Mayo Clinic, Dr. Wijdicks uses his extensive knowledge to discuss a new practical multistep approach to the diagnosis of the comatose patient. Additionally, this edition includes extensive coverage of the interpretation of neuroimaging and its role in daily practice and decision making, as well as management in the emergency room and ICU. Dr. Wijdicks details long-term supportive care and an appropriate approach to communication with family members about end-of-life decision making. In addition, video clips on neurologic examination and neurologic manifestations seen in comatose patients can be found here: http://oxfordmedicine.com/comatosepatient2e. All video recordings from the first edition have been reformatted and remastered for optimal use, and several more video clips of patients have also been included. |
| altered mental status assessment: Practice Guideline for the Treatment of Patients with Delirium American Psychiatric Association, 1999 TABLE OF CONTENTS: Statement of Intent. Introduction. Development Process. I. Summary of Recommendations. A. Coding System. B. General Considerations. II. Disease Definition, Epidemiology. and Natural History. A. Definition and Clinical Features. B. Associated Features. C. Differential Diagnosis. D. Prevalence and Course. E. Causes. F. Use of Formal Measures. III. Treatment Principles and Alternatives. A. Psychiatric Management. B. Environmental and Supportive Interventions. C. Somatic Interventions. IV. Formulation and Implimentation of a Treatment Plan. A. Psychiatric Management. B. Choice of Specific Environmental and Supportive Interventions. C. Choice of Somatic Intervention. D. Issues of Competency and Consent. V. Clinical Features Influencing Treatment. A. Comorbid Psychiatric Disorders. B. Comorbid General Medical Conditions. C. Advanced Age. VI. Reviewers and Reviewing Organizations. VII. References. |
| altered mental status assessment: Cognitive Screening Instruments A. J. Larner, 2016-11-30 This revised and updated second edition provides a practical and structured overview of some of the most commonly used and easily available cognitive screening instruments applicable in the outpatient clinic and bedside setting. It now includes additional chapters on AD8 and also methodological aspects of systematic cognitive screening instrument assessment from the Cochrane Dementia and Cognitive Improvement Group. Expert authors from around the world equip the reader with clear instructions on the usage of each screening instrument, its strengths and weaknesses, and the time required for administration. Rules on scoring are also provided, such as how to correct for variations in the patient’s age or education, and suggested cut-off scores. Cognitive Screening Instruments: A Practical Approach, Second Edition is aimed at both clinicians and professionals in disciplines allied to medicine who are called upon to assess patients with possible cognitive disorders, including neurologists, old age psychiatrists, neuropsychologists, primary care physicians, dementia support workers, and members of memory assessment teams. |
| altered mental status assessment: Tintinalli's Emergency Medicine Judith E. Tintinalli, J. Stephan Stapczynski, 2011-01-01 With 418 contributors representing over 120 medical centers from around the world, this book comprehensively covers the entire field of emergency medicine -- from prehospital care, disaster preparedness, and basic resuscitative techniques -- to all the major diseases and disorders encountered in the emergency department. Unquestionably the leading text in the field, this is a true must-have reference for everyone in emergency medicine from residents to practicing physicians. The Seventh Edition is highlighted by a new full-color presentation, a companion DVD with 17 additional chapters, a greater international focus, and innovative new features and content. |
| altered mental status assessment: Clinical Mentation Evaluation Michael Hoffmann, 2020-05-31 This first-of-its-kind book offers clinicians a unique and comprehensive system of cognitive and behavioral testing that is tiered and context-appropriate for the diagnosis of mental status. Because the challenge nowadays with neurologic syndrome presentations is no longer merely lesion localization, but the degree, extent and nature of a cognitive and/or behavioral impairment, this work proposes a more targeted system of mentation evaluation -- one that incorporates behavioral, neurological, neuropsychiatric, and neuropsychological components. Developed by synthesizing outcomes data from a range of stroke registries, this novel work offers a stepwise, hierarchical approach to mentation evaluation largely determined by level of consciousness and degree of cooperation. Organized across 14 chapters, the book begins with an introduction to the challenges of cognitive and behavioral assessment, as well as a discussion of various clinical presentations ranging from mild behavioral impairment to cognitive reserve and its implications. Subsequent chapters then address various approaches to mental status evaluation and explore how these tests affect brain physiology. The work closes with a unique discussion of the various lay populations that may benefit from cognitive and behavioral evaluation. Authored by a renowned expert in the field, Clinical Mentation Evaluation: A Connectomal Approach to Rapid and Comprehensive Assessment is an invaluable reference that seeks to revitalize neurological and psychiatric disease measurement within the clinical setting. The work will be of interest to all clinicians in training and clinical practice who regularly, or even periodically, conduct mental status examination. |
| altered mental status assessment: Delirium in Critical Care Valerie J. Page, E. Wesley Ely, 2015-03-12 The fully updated second edition of this popular handbook concisely summarises all current knowledge about delirium in critically ill patients and describes simple tools the bedside clinician can use to prevent, diagnose and manage delirium. Chapters discuss new developments in assessing risk and diagnosis, crucial discoveries regarding delirium and long-term cognitive outcomes, and dangers of sedation and death. Updated management advice reflects new evidence about antipsychotics and delirium. This book explains how to minimise the risks of delirium, drugs to avoid, drugs to use and when to use them, as well as current theories regarding pathophysiology, different motoric subtypes leading to missed diagnosis, and the adverse impact of delirium on patient outcomes. While there are still unanswered questions, this edition contains all the available answers. Illustrated with real-life case reports, Delirium in Critical Care is essential reading for trainees, consultants and nurses in the ICU and emergency department. |
| altered mental status assessment: Psychiatry and Heart Disease Michelle Riba, Lawson Wulsin, Melvyn Rubenfire, Divy Ravindranath, 2012-01-31 This unique book will help psychiatrists to understand better the risks of cardiovascular illness and cardiologists to appreciate possible pathophysiological links with psychiatric conditions. It describes the common psychiatric conditions, their key features and how they may influence cardiovascular disease, outcomes, and quality of life. It also considers the cardiovascular complications that may arise as a result of mental illness. In an exciting, collaborative approach, psychiatrists and cardiologists combine their expertise throughout the book to provide guidance on the best way to manage such patients, considering the patient as a whole, not the individual conditions. |
| altered mental status assessment: Fast Facts for the Medical- Surgical Nurse Maggie Ciocco, MS, RN, BC, 2014-08-26 Written for registered nurses in orientation, this concise, user-friendly resource provides a complete picture of all components of excellent patient care on a busy medical-surgical nursing unit. It covers assessment, key clinical skills/procedures, and documentation of care in an easily digestible, bulleted format. Time-tested guidance about new nurse orientation to professional practice includes ìproven pearls for success.î Content is current and evidence-based, and reinforces previously mastered skills in ìkey points to rememberî sections. The theme of ìthe big pictureî of patient care is a consistent thread throughout. Clinical chaptersóorganized by body system for easy reference--present common conditions seen in medical-surgical nursing and unit emergencies, along with focused assessments, lab work overview, related procedures and skills, a documentation guide, and common medications including those for pain management. Chapters also cover pre-operative and post-operative care for all conditions. Several ìmust-have sectionsî include an orientation guide describing what new nurses can expect as they embrace their new role. This section addresses co-workers and supervisors, finding a mentor, hourly rounding, HIPAA reminders, and telephone skills/customer relations. Another section is devoted to all aspects of infection control, and an appendix provides a wealth of resources and supporting information of particular value to the new nurse. Key Features: Provides concise, user-friendly, evidence-based guidance about the ìwhole pictureî of nursing on a medical-surgical or sub-acute unit Presents a unique orientation section offering ìproven pearls for successî Contains focused assessment guides, skills overview, documentation tips, and medications for common medical-surgical conditions and emergencies Addresses pre- and post-operative care and pain control Covers important protocols regarding infection control |
| altered mental status assessment: Guccione's Geriatric Physical Therapy E-Book Dale Avers, Rita Wong, 2019-10-24 **Selected for Doody's Core Titles® 2024 in Physical Therapy** Offering a comprehensive look at physical therapy science and practice, Guccione's Geriatric Physical Therapy, 4th Edition is a perfect resource for both students and practitioners alike. Year after year, this text is recommended as the primary preparatory resource for the Geriatric Physical Therapy Specialization exam. And this new fourth edition only gets better. Content is thoroughly revised to keep you up to date on the latest geriatric physical therapy protocols and conditions. Five new chapters are added to this edition to help you learn how to better manage common orthopedic, cardiopulmonary, and neurologic conditions; become familiar with functional outcomes and assessments; and better understand the psychosocial aspects of aging. In all, you can rely on Guccione's Geriatric Physical Therapy to help you effectively care for today's aging patient population. - Comprehensive coverage of geriatric physical therapy prepares students and clinicians to provide thoughtful, evidence-based care for aging patients. - Combination of foundational knowledge and clinically relevant information provides a meaningful background in how to effectively manage geriatric disorders - Updated information reflects the most recent and relevant information on the Geriatric Clinical Specialty Exam. - Standard APTA terminology prepares students for terms they will hear in practice. - Expert authorship ensures all information is authoritative, current, and clinically accurate. - NEW! Thoroughly revised and updated content across all chapters keeps students up to date with the latest geriatric physical therapy protocols and conditions. - NEW! References located at the end of each chapter point students toward credible external sources for further information. - NEW! Treatment chapters guide students in managing common conditions in orthopedics, cardiopulmonary, and neurology. - NEW! Chapter on functional outcomes and assessment lists relevant scores for the most frequently used tests. - NEW! Chapter on psychosocial aspects of aging provides a well-rounded view of the social and mental conditions commonly affecting geriatric patients. - NEW! Chapter on frailty covers a wide variety of interventions to optimize treatment. - NEW! Enhanced eBook version is included with print purchase, allowing students to access all of the text, figures, and references from the book on a variety of devices. |
| altered mental status assessment: The Complementary Therapist's Guide to Red Flags and Referrals Clare Stephenson, 2011-10-11 Unique ready reference for all complementary medicine, massage therapy and manual therapy practitioners and students alerting them to 'red flag' symptoms which should be referred for Western medical investigation or emergency medical treatment. When can a patient be safely reassured and when do they need further investigation or treatment? 'Red flags' are clinical signs that suggest a patient needs prompt investigation and treatment for a potentially dangerous situation. Therapists increasingly find themselves working alongside conventionally trained doctors and nurses and it is vital for them to understand conventional medical diagnoses, symptoms and treatments and, crucially, to recognise warning signs of serious disease. This is essential in order to be a safe practitioner. Clare Stephenson's The Complementary Therapist's Guide to Red Flags and Referrals meets this need by providing an easily accessible reference to 'red flag' symptoms, designed especially for therapists. It offers guidance on how best to respond to those symptoms and signs of disease which can be readily discerned through routine history taking and basic examination of the body. The guidance is in language which is accessible to therapists, and clear advice is offered on when to refer patients to conventional medicine practitioners and how to communicate with doctors when making a referral. Clinical syndromes which merit rapid response are summarised for ease of reference. |
| altered mental status assessment: Advanced Medical Life Support Alice Dalton, 2003 Advanced Medical Life Support is the text on practical methods for adult emergency treatment. Designed to provide students with the practical knowledge and skills to effectively manage on-scene, adult medical emergencies, each chapter moves from assessment-based procedures to field diagnosis and management of treatable cause. Written by authors uniquely qualified to address the specific requirements of advanced-level EMS training, this is a complete and essential resource for seasoned EMS practitioners. Features: Highlights definitions, key ideas, and Clinical Insights in the margin. Introduces each chapter with a relevant case study and concludes the chapter with a follow-up to that same case study. Teaches critical thinking (Possibilities to Probabilities in Chapter 1). Applies critical thinking through interactive case studies (Chapter 13) Includes a Further Reading bibliography in each chapter. Contains appendices on pharmacology, normal lab data, and 12-lead ECG interpretation. |
| altered mental status assessment: Mechanisms of Organ Dysfunction in Critical Illness Timothy W. Evans, Mitchell P. Fink, 2002-01-21 The pathophysiology of sepsis can be regarded as a series of steps, beginning with the invasion of normally sterile tissue by microbes and the elaboration of various pro-inflammatory mediators. The final common pathway is often the development of the multiple organ dysfunction syndrome (MODS). Whereas a great deal has been learned during the past quarter century about the inflammatory processes associated with sepsis (and other related conditions, such as ischemia/reperfusion injury), our understanding is far less developed with respect to the pathophysiological events that lead to organ dysfunction under these conditions. Nevertheless, efforts by both clinical and laboratory scientists are leading to new knowledge in this area. The chapters in this volume provide a state-of-the-art overview of many aspects of the pathophysiology of organ dysfunction in critical illness. |
| altered mental status assessment: Red Book Atlas of Pediatric Infectious Diseases American Academy of Pediatrics, 2007 Based on key content from Red Book: 2006 Report of the Committee on Infectious Diseases, 27th Edition, the new Red Bookr Atlas is a useful quick reference tool for the clinical diagnosis and treatment of more than 75 of the most commonly seen pediatric infectious diseases. Includes more than 500 full-color images adjacent to concise diagnostic and treatment guidelines. Essential information on each condition is presented in the precise sequence needed in the clinical setting: Clinical manifestations, Etiology, Epidemiology, Incubation period, Diagnostic tests, Treatment |
| altered mental status assessment: Oxford Handbook of Critical Care Nursing Fiona Creed, Jessica Hargreaves, 2016-01-28 Focused on the practical issues of nursing care and nursing procedures, the Oxford Handbook of Critical Care Nursing has been written by nurses, for nurses Reflecting current best practice, this handbook is an easily accessible and evidence-based guide for all levels of nursing staff working in critical care environments. It provides the nurse at the bedside with the answers to day-to-day problems experienced when caring for critically ill patients, and is also a guide to some of the less commonly encountered issues. Now including more detail on the psychological issues facing critically ill patients and further information on the intricacies of receiving and transferring critically ill patients to and from critical care environments, this handbook is a concise, practical, evidence-based guide for nursing professionals caring for critically ill patients |
| altered mental status assessment: Essentials of Neurosurgical Anesthesia & Critical Care Ansgar M. Brambrink, Jeffrey R. Kirsch, 2011-12-23 This handbook is aimed at first-line health care providers involved in the perioperative care of adult and pediatric neurosurgical patients. It is unique in its systematic focus on how to deal with common and important clinical challenges encountered in day-to-day practice in the OR, the PACU, and the ICU and is designed as a problem-solving tool for all members of the perioperative medicine team: trainees and faculty in anesthesiology, neurosurgery, and critical care; nurses; nurse anesthetists; and physician’s assistants. • Encompasses clinical continuum from neurosurgical pre-op to critical care – plus anesthesia in neuroradiology • Adult and pediatric care • Structured algorithmic approach supports clinical decision-making • Succinct presentation of clinically relevant basic science • End-of-chapter summaries, with suggestions for further reading • Collaborative approach and multidisciplinary nature of perioperative medicine emphasized • Extensive summary tables • Portable and formatted for quick retrieval of information • Ideal for use in the OR, the PACU, and the ICU |
| altered mental status assessment: Neuroradiology Juan E. Small, Daniel L. Noujaim, Daniel T. Ginat, Hillary R. Kelly, Pamela W. Schaefer, 2018-08-10 Acquire a better understanding of disease evolution and treatment response with Neuroradiology Spectrum and Evolution of Disease. The unique format includes carefully chosen clinical images that depict the pathologic evolution of disease from initial presentation across the continuum of progression. Colorful graphics plot characteristic changes, helping you visualize how normal and abnormal variations alter over time. Extensive illustrations and concise descriptions distill complex concepts, making this first-of-its-kind resource an excellent tool for imaging interpretation and clinical problem solving. - Presents neurologic disease from a novel imaging perspective, emphasizing evolutionary development and pointing out patterns to recognize. - Provides a state-of-the-art understanding of image interpretation based on early, middle, and late imaging characteristics; typical and atypical variants; and pre-treatment, post-treatment, progression, and regression characteristics. - Guides you through the progression of disease with chronological indicators, additional clinical images and descriptions, and annotations that highlight atypical findings – for an easy-to-digest, visually memorable presentation. - Helps you correctly interpret specific imaging characteristics you have never seen, even when the disease process is one you are familiar with. |
| altered mental status assessment: Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Care Services, Committee on the Review of the Department of Veterans Affairs Examinations for Traumatic Brain Injury, 2019-05-20 The Veterans Benefits Administration (VBA) provides disability compensation to veterans with a service-connected injury, and to receive disability compensation from the Department of Veterans Affairs (VA), a veteran must submit a claim or have a claim submitted on his or her behalf. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans reviews the process by which the VA assesses impairments resulting from traumatic brain injury for purposes of awarding disability compensation. This report also provides recommendations for legislative or administrative action for improving the adjudication of veterans' claims seeking entitlement to compensation for all impairments arising from a traumatic brain injury. |
| altered mental status assessment: Assessment of Older Adults with Diminished Capacity Jennifer Moye, 2005 |
| altered mental status assessment: Cerebrospinal Fluid Biomarkers Charlotte E. Teunissen, Henrik Zetterberg, 2022-05-19 This volume covers the latest methods used in clinical neurochemistry laboratories for both clinical practice and research. Chapters in this book discuss topics such as techniques for cerebrospinal fluid (CSF) collection, pre-analytical processing, and basic CSF analysis; an examination of biomarkers including ELISA and automated immunochemical assays for amyloid and tau markers for Alzheimer’s disease; the analysis of neurofilaments by digital ELISA; and an example of successful novel immunoassay development. In the Neuromethods series style, chapters include the kind of detail and key advice from the specialists needed to get successful results in your laboratory. Cutting-edge and thorough, Cerebrospinal Fluid Biomarkers is a valuable resource for clinicians and researchers to use in CSF labs and CSF courses. |
| altered mental status assessment: ABC of Psychological Medicine Richard Mayou, Michael Sharpe, Alan Carson, 2003-02-14 This book provides both the evidence and the guidance to enable doctors to improve their assessment and management of the psychological and behavioural aspects of the most common problems presenting in general medical care. It summarises the recent research evidence and provides common sense guidance on how psychological and psychiatric aspects of illness can be addressed within the medical consultation. |
| altered mental status assessment: Tintinalli's Emergency Medicine: Just the Facts, Third Edition David M. Cline, O. John Ma, 2012-10-06 Put the authority of Tintinalli’s into your emergency medicine review! A Doody's Core Title for 2015! Published in partnership with The American College of Emergency Physicians Derived from Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Seventh Edition, this streamlined text is the perfect review for any emergency medicine exam -- or for use as a clinical refresher. Its concise, bulleted design condenses and simplifies must-know concepts and helps you make the most of your study time. This authoritative study guide includes radiographs, color images, line drawings, and ECGs, all designed to enhance your understanding of the material and help you meet the challenges of visual diagnosis in practice and exam situations. Features Updated to reflect the latest advances in diagnostic imaging NEW CHAPTERS on Hematologic-Oncologic Emergencies, Renal Emergencies in Children, Low Probability Coronary Syndromes, Urinary Retention, Food and Water-Borne Diseases, and World Travelers Increased coverage of toxicology and trauma More than 300 tables encapsulate important information More than 100 radiographs/color images and 90 line drawings/ECGs aid recognition of challenging and life-threatening disorders Provides a brief yet comprehensive review of the practice of emergency medicine for clinicians who wish to update their knowledge of the specialty |
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