Description: Altered mental status differential and plan in the form of an Epic dot phrase / smart phrase.

AMS:: Hypoxia vs. Infection vs. TIA/stroke vs. Metabolic/Toxic. Dementia an unlikely cause given rapidity of onset.

  • Hypoxia:
    • ED O2 sat showed ***
    • Continuous O2 NC and pulse ox – maintain O2 sat > 95%
    • CXR shows: ***PNA, effusion, COPD, edema
    • PE risk, Wells score:
      • ***clinically suspected DVT – 3 points
      • ***alternative diagnosis is less likely than PE – 3.0 points
      • ***tachycardia – 1.5 points
      • ***immobilization/surgery in previous four weeks – 1.5 points
      • ***history of DVT or PE – 1.5 points
      • ***hemoptysis – 1.0 points
      • ***malignancy (treatment for within 6 months, palliative) – 1.0 points
      • Interpretation (Stein et al. 2007 Radiology 242:15-21)
      • Score >6.0 – High (probability 59% based on pooled data)
      • Score 2.0 to 6.0 – Moderate (probability 29% based on pooled data)
      • Score <2.0 – Low (probability 15% based on pooled data)
    • Infection: *** of 4 SIRS criteria: @BRIEFLAB(WBC)@, *** left shift, *** HR, *** RR, @TMAX(24)@
      • UA w/ reflex culture ***
      • Blood cultures x2 ***
      • CXR shows***
      • Physical exam findings ***not suggestive of meningitis: ***
      • ***Season ***not appropriate to West Nile
    • TIA/stroke
      • History of TIA/CVA ***
      • *** focal findings on physical exam
      • ***No early signs of stroke on Head CT, ***no hemorrhage or acute findings.
      • AMS started ***; in***out of TPA window.
      • ***Permissive HTN
      • ***Carotid dopplers ***MRA
      • Brain MRI***
      • ***EEG
    • Metabolic
      • Electrolytes ***
      • TSH ***
      • New medicines ***
      • Recently stopped medicines ***
      • Tox screen ***

     

    Topics #altered mental status #AMS #differential diagnosis #epic #smart phrase