ams - psychological emergencies cme 2007
TRANSCRIPT
AMS and Psychological AMS and Psychological EmergenciesEmergencies
Brown University EMSMarch 4, 2007
What is AMS?What is AMS?
Altered mental status: a condition in which the patient displays a change in his/her normal mental state ranging from disorientation to complete unresponsiveness
What Causes AMS?What Causes AMS? Traumatic head injury
Poisoning or drug overdose
Intoxication
Post-seizure
Infection
Shock
Hypoxia
Stroke
Diabetes
Signs and Symptoms: Signs and Symptoms: TraumaTrauma
Obvious trauma (DCAP-BTLS)
Abnormal respirations
Abnormal heart rate
Unequal or sluggish pupils
Hypo/hypertension
Pale, cool, moist skin
Posturing
Raccoon eyes (late sign)
Battle’s signs (late sign)
Signs and Symptoms: Signs and Symptoms: MedicalMedical
Abnormal respirations
Abnormal heart rate
Abnormal skin condition
Unequal or sluggish pupils
Stiff neck
Seizure activity
Hypertension and bradycardia
Bowel/bladder incontinence
Irregular blood glucose level
Signs and Symptoms: Signs and Symptoms: DiabetesDiabetes
Irregular blood glucose level:
Hypoglycemia (<60mg/dl w.signs; <50mg/dl w/o signs)
Hyperglycemia (>120mg/dl)
Seizure activity
Stroke-like symptoms
Combativeness or bizarre behavior
Anxiousness/restlessness
Rapid AMS onset
Intoxicated appearance
Tachycardia
Cool, moist skin
Hunger
Signs and Symptoms: Signs and Symptoms: IntoxicationIntoxication
25% of calls at Brown!
Symptoms depend on class of drugs
CNS Stimulants
CNS Depressants
Narcotics
Hallucinogens
Volatile Inhalants
AssessmentAssessment Initial assessment:
Stabilize c-spine if trauma cannot be ruled out
ABCs
SAMPLE history
Baseline vital signs
Include blood glucose
Physical exam:
Head and pupils
Mouth and oral mucosa
Chest and breath sounds
Abdomen, extremities, posterior
Assessment (cont’d)Assessment (cont’d) Check the scene for evidence of:
Rx or OTC medication (including insulin)
Drug or alcohol abuse
Oxygen tanks
Unusual odors (gas, poisons)
Transport decision:
Patients with AMS fall under implied consent and must be transported
Behavioral EmergencyBehavioral Emergency A situation in which a person may
exhibit panic, agitation, or bizarre thinking or actions
Examples of psychological emergencies:
Anxiety
Phobias
Depression
Bipolar disorder
Paranoia
Schizophrenia
Suicidal ideations
Causes of Behavioral Causes of Behavioral ChangesChanges
Abuse/traumatic event
Traumatic head injury
Poisoning or drug overdose
Infection
Shock
Hypoxia
Stroke
Diabetes
Excessive heat/cold
Psych vs. AMSPsych vs. AMS
AMS
Sudden onset
Visual hallucinations
CAOx<3
Abnormal pupils
Excessive salivation
Incontinence
Psych
Gradual onset
Auditory/visual hallucinations
CAOx3
PEARRL
AssessmentAssessment Initial assessment
SAMPLE history
Baseline vital signs
Physical exam
Be sure to rule out a physical emergency!
Keep In Mind…Keep In Mind… Emotional injury is just as real as physical
injury
Speak calmly and be reassuring
Maintain a comfortable distance
Maintain eye contact
Respond honestly
Never threaten or challenge the patient
Do not play into hallucinations
Do not touch the patient without his/her consent
Never leave the patient alone