AMS
Causes
CNS insults, Systemic Infections, Metabolic Disturbances, Toxin Exposure, Medications, Chronic Systemic Diseases, Psychiatric conditions
Definition
Change in consciousness, appearance, behavior, mood, affect, motor activity or cognitive function
Best Practice
Do not assume a diagnosis of dementia in elderly patients with AMS without assessing for delirium
Do not use physical or chemical restraints, outside of emergency situations. Assess for unmet needs or environmental triggers
Evaluation:
As the differential is broad, history and physical exam is always the first step to determine diagnostic testing.
- Evaluate ABC's
- Vitals, glucose, H&P
- Diagnostic studies as indicated by H&P
- Neuroimaging
- MRI brain or EEG or LP
- If still unclear, specialty consultation
Treatment
Definitive treatment is removal of the underlying cause
However, if patients' behaviors threaten self or others, then attempt nonpharmacologic interventions are the treatment of choice. This includes reassurance, family, friends and environmental factors.
Medications are used only when nonpharmacologic treatments are ineffective and only when it is essential to control behavior. These include antipsychotics, benzodiazepines and ketamine, but they contraindications and FDA warnings.
Recent-Onset Altered Mental Status: Evaluation and Management - American Family Physician (aafp.org)
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