1. MAJA PRŠLE Mentor: A. Žmegač Horvat

2. ALTERED MENTAL STATUS INDICATIVE OF: central nervous system (CNS) injury or illness Mental status : clinical state of emotional and intellectual functioning of the individual

3. What is consciousness? Arousal function – a lertness and wakefulness – a natomically  reticular activating system Content functions – l anguage, reasoning – a natomically  cerebral cortex

4. Disruptions of consciousness Arousal functions (and/or) Content functions disrupted

5. Altered mental status may present as: mild confusion  complete unconsciousness (coma) Methods of evaluation: Glasgow Coma Scale (best eye, verbal and motor response) or AVPU ( A lert, V erbal stimuli, P ainful stimuli, U nresponsive) or MINI MENTAL state examination (qualitative method for assessing cognitive impairment)

6. EXAMPLES ACUTE CONFUSIONAL STATE ACUTE COGNITIVE IMPAIRMENT DELIRIUM (acute encephalopathy) COMA

7. “SMASHED”- m nemonic f or a cute m ental s tatus c hange SSubstrates( hyperglycemia, hypoglycemia, thiamine ) Sepsis MMeningitis( meningitis and other CNS infections ) Mental illness( functional psychoses ) AAlcohol( intoxication, withdrawal ) SSeizures( seizure activity, post-ictal states ) Stimulants( anticholinergics, hallucinogens, cocaine ) HHyper( hyperthyroidism, hyperthermia, hypercarbia ) Hypo( hypotension, hypothyroidism, hypoxia, hypothermia ) EElectrolytes( hypernatremia, hyponatremia, hypercalcemia ) Encephalopathy ( hepatic, uremic, hypertensive ) DDrugs of any sort

8. DELIRIUM r educed level of consciousness p erceptual disturbances: misinterpretations, illusions or hallucinations d isturbance of wake-sleep cycle i ncreased OR decreased psychomotor activity d isorientation to time, place, or person m emory impairment

9. DELIRIUM 4 general causes 1.p rimary intracranial disease 2.s ystemic disease affecting CNS 3.e xogenous toxins 4.d rug withdrawal TREAT THE UNDERLYING CAUSE! + PROVIDE ALS IF NEEDED

10. COMA s tate of reduced alertness and responsiveness from which you cannot be aroused Glasgow Coma Scale – SCORE 3-15  COMA SCORE IS 3-8 (best EYE, VERBAL and MOTOR response)