![]() ![]() Opioid toxidrome (or suspicion): Naloxone 0.2-0.4mg IV q2-3min.At this point, I am ready to consider if any immediate therapeutic interventions are required: This all takes about 1 minute to complete. #Altered mental status differential skin#Signs of shock: Cap refill, skin warm or cold?.Breathing pattern: Regular, Cheyne-Stokes, irregular, apnea?.Signs of impending herniation: Hypertension, bradycardia, and irregular respirations (Cushing’s triad) posturing unilateral blown pupil?.Neuro: Pupils, eye movements, corneal reflex, moving all 4 extremities, reflexes, muscle tone, any asymmetry?.Next, I ask my nurses to start working on vascular access while I perform a rapid, focused primary survey: My first priority is getting the glucose checked, primarily so it does not get overlooked. Intracranial hypertension and herniation.What could kill my patient in the next few minutes? ![]() The patient can’t communicate and the paramedics almost always have important information. NOTE: Don’t forget to get the history from EMS before they leave. ![]() (I don’t want to intubate a patient who only requires D50W or narcan.) The need for c-spine precautions should also be considered. If necessary, I start with basic, temporizing airway maneuvers, such as positioning, oral/nasal airways, or an LMA. Next, I assess airway patency and breathing pattern. #Altered mental status differential full#At the same time, my nurses are getting the patient on the monitor and getting a full set of vital signs. The immediate first step is to check for a pulse. I try to sort through diagnoses based on how quickly they could kill the patient and how quickly I can treat them. The differential diagnosis of altered mental status is huge and can be overwhelming in the face of an acutely ill, undifferentiated emergency department patient. They were called after his family found him unconscious at home. You are called into resuscitation, where EMS has just finished transferring a 55 year old man onto the ED stretcher. ![]()
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