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Encephalopathy In A Nutshell

Although not the definitive, all encompassing, reasons for encephalopathy/delirium/altered mental status, this short list certainly covers many of the most prevalent causes:
  • Bugs
  • Drugs
  • Lytes
  • Plights
  • Beating
  • Bleeding
  • Gases
  • Glucose
  • Gourd
Etiology Physical Exam Bedside Diagnostic Tests History STAT Diagnostic Tests
"Bugs"
Infection
Temperature
SpO2
Meningeal signs
Lines (vascular, GI, GU)
Headache
Aspiration
Productive cough
Vomiting / Diarrhea
Urinary changes
CXR
UA and urine c/s
Blood c/s
Sputum c/s
C. difficile toxin
"Drugs"
Side effects of and withdrawal from drugs
Naloxone trial MAR (narcotics, corticosteroids, CNS agents)
Review home medications
Alcohol/substance abuse
"Lytes"
Electrolyte abnormalities particularly hypo- and hyperosmolar states
I-STAT Ins/Outs BMP
Serum osmolarity
"Plights"
Inadequate pain control
Urinary retention
Constipation
Pain scale
Abdominal examination
Rectal examination
Bladder scan
"Beating"
Cardiac arrhythmia and ischemia
Heart rate
Blood pressure
Jugular venous pulsation
Heart murmurs and additional sounds
Telemetry
I-STAT Troponin
EKG
Cardiac markers
BNP
"Bleeding"
Acute blood loss
Scleral pallor
Rectal exam
Fecal occult blood test
I-STAT
(ABG also has an H&H)
Recent surgery
Anticoagulation
CBC
"Gases"
Hypoxemia or hypercarbia
Acidosis or alkalosis
Respiratory rate
SpO2
ABG History of hypercarbia
Previous ABG
"Glucose"
Hypo- and hyperglycemia
Accu-check
I-STAT
Diabetes mellitus
Insulin or oral antihyperglycemic medications
"Gourd"
Intracranial pathology (i.e. stroke, mass effect, traumatic brain injury)
Seizure
Neurological examination Documentation of seizure-like activity without formal history of seizure
Trauma
History of dementia or seizure
CT head without contrast


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