2015 Guidelines for Altered Mental Status (AMS) Published

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The American Academy of Neurology (AAN) has updated their guidelines for managing altered mental status (AMS) patients coming into the emergency department.
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  • https://www.facebook.com/josh.lovinger Josh Lovinger

    And would alter the algorithm a bit; it needs way more useless tests like checking a B12 level.

  • https://www.facebook.com/josh.lovinger Josh Lovinger

    proudest resid. moment was stroke alert w neg alcohol, serum and utox, with +glycol panel :).

  • https://www.facebook.com/amy.hulton Amy C. Hulton

    Psych is on the algorithm..

  • https://www.facebook.com/profile.php?id=100008723793408 Rajnee Dhawan

    Hilarious !Takes my stress away at the end of the day !

  • https://www.facebook.com/traci.k.anderson.9 Traci Kane Anderson

    Or request psych bed on initial arrival- prior to any foolish UA.

  • https://www.facebook.com/angela.spencer.925 Angela Spencer

    way too simplified, cookie-cutter way but helps some who need guidance

  • https://www.facebook.com/diane.bockelman Diane Bockelman

    So good!

  • https://www.facebook.com/DoniBernd Doni Bernd-Phelps

    Pretty much…

  • https://www.facebook.com/rjscoggin Rikki J Scoggin

    Love the fact that the neurological service is never mentioned. Stroke dodging bastards. Surprised the protocol left off the big letters at the bottom: IF ALL ELSE FAILS CALL THE FP, MURMUR SOMETHING UNINTELLIGIBLE AND GIVE A ROOM NUMBER. IF THE FP DARES TO SPEAK SCREAM “YOU’RE THE PRIMARY” IN AN AGITATED TONE, SET OFF A RANDOM ALARM IN THE ER AND PUT THE PHONE DOWN ON THE DESK. AS YOUR VOICE FADES INTO THE DISTANCE HAVE A RANDOM NURSE HANG IT UP. PRACTICE THIS DRILL WITH SEVERAL NURSES. Bonus points if the FP service never figures out what your admitting diagnosis was. Double bonus points if pt gets to the floor and the FP name is on the chart before the labs come back. Triple bonus points if all of the above is true AND the patient has no IV access. Sweepstakes prize if the pt is non communicative and was on the medicine service last week and was discharged home with an elderly spouse prior to the 3 days needed for SNF placement… I can play this game all night.

  • https://www.facebook.com/kelly.averill.5 Kelly Averill

    Damn it, they’re on to us: Leon Leon Grant, Jitesh Kar, Proleta Datta, Michelle Christie, Keely Fitzgerald

  • https://www.facebook.com/haley.johnson1 Haley Johnson

    Alex Josiah Dunn yes, yes we did

  • https://www.facebook.com/anne.clinton.14 Anne Clinton

    Ok we have similar decision tree jokes in tech so now am aware of how not funny they are to layman

  • https://www.facebook.com/arwooley Angela R. Wooley

    Hummmm John Dempster can you translate?

  • https://www.facebook.com/kathleen.sullivanfierro Kathleen Sullivan Fierro

    Truth in satire!

  • https://www.facebook.com/jim.seeman.39 Jim Seeman

    It all looks good to me!

  • https://www.facebook.com/christina.holzwarth.7 Christina Holzwarth

    Ha!

  • https://www.facebook.com/david.weisman.77 David Weisman

    I can always find the UTI. The problem is that I don’t go home, just off to the next brain.

  • https://www.facebook.com/dempster.john John Dempster

    You forgot “review chart for ED staff and tell them reason for identical presentation the pt had last month” and “beg for tox screen”

  • https://www.facebook.com/brandi.anderson.587 Brandi Anderson

    Brady Nutzman

  • https://www.facebook.com/cristisha Christie Shanafelt

    Blame the Seroquel and trazodone. That way Narcan shouldn’t work.

  • https://www.facebook.com/emily.schwartzdewey Emily Schwartz Dewey
  • https://www.facebook.com/christopher.wright.3344 Christopher Wright

    Somewhere before “probably a stroke”, there should be discontinue all anticholinergic drugs, go home and have a scotch.

  • https://www.facebook.com/brady.nutzman Brady Nutzman

    Brandi Anderson

  • https://www.facebook.com/bakerj88 John K. Baker

    Let’s include statistics in the manual here…AMS is about 5% of the time primary neurologic? Thanks for the consult. Let’s not check a sugar, get the 14th head CT this year, and call a consult. Ha.

  • https://www.facebook.com/alex.j.dunn.1 Alex Josiah Dunn

    Haley did we write this?

  • https://www.facebook.com/RCWetz Colin Wetz

    I didn’t see “yell at the internist” on the algorithm

  • https://www.facebook.com/heather.day.509 Heather Day

    Surprisingly accurate…

  • https://www.facebook.com/jonathan.longoria.10 Jon Longoria

    Mohammad, Dustin, Nitish: LOL!

  • https://www.facebook.com/christopher.wright.3344 Christopher Wright

    Yup. I don’t need a practice parameter for that. It’s just good medicine!

  • https://www.facebook.com/david.wyler.3 David Wyler

    How about the dreaded, “We are just a consult service, we don’t admit.” Then in the AM when they still haven’t seen the patient, “I didn’t realize you wanted a consult.”

  • https://www.facebook.com/michael.flamoe Michael Flamoe

    Matthew Thompson

  • https://www.facebook.com/m0nkie Monica Airaf

    genius

  • https://www.facebook.com/joanie.sapienza.1 Joanie Sapienza

    Hahahhahahahahhahaahahahhauahahauauauuauauaauauuauauwuwuwuwuwwuwuuwu!

  • https://www.facebook.com/sonya.addison Sonya Addison

    They forgot a step off of “probably a stroke.” –> Has one of the following: diabetes, pneumonia, CAD, COPD, polypharmacy, or finger pain –> Turf to medicine, act as a neuro consult.

  • https://www.facebook.com/genepaul.matson Gene-Paul Matson

    I’m honored they have a flow chart just for me.

  • https://www.facebook.com/laura.r.young.3 Laura Rogan Young

    Lol!!

  • https://www.facebook.com/elizabeth.purling Elizabeth Purling

    Michelle – do you want me to laminate these new neuro guidelines and put this in each of the protocol notebooks?

  • https://www.facebook.com/jeff.chambers.315 Jeff Chambers

    They forgot to add “patient faking stroke symptoms” call Psych!

  • https://www.facebook.com/warren.carll Warren Carll

    Mark Omar Waheed

  • https://www.facebook.com/melanie.nordlinger Melanie Nordlinger

    David Weisman Brad Klein

  • https://www.facebook.com/blaumau5 Kerri West

    Hahaha oh my. This is amazing.

  • https://www.facebook.com/emma.costello.39 Emma Costello

    Craig Costello

  • https://www.facebook.com/LuvManatee Hannah Hfr

    always check the urine for drugs… cc Matthew Josh Akhila Katherine Shon David

  • https://www.facebook.com/jennifer.hablewitz.7 Jennifer Kirsch

    Marc Wasserman, are these all of your diagnosis secrets??

  • https://www.facebook.com/rebecca.olson.230 Rebecca Bakkestuen

    Terri McDaniel Todd

  • https://www.facebook.com/brandy.daly.35 Brandy Daly

    Christian Basque George Rucco

  • https://www.facebook.com/lora.cullipher Lora Ann Cullipher

    Lots of punting going on here.

  • https://www.facebook.com/heidi.w.duckworth Heidi Wheeler Duckworth

    But you’ve missed the step where you blame the narcotics, even when the Narcan doesn’t change the patient’s status…

  • https://www.facebook.com/andreacollinskelly Andrea Collins Kelly

    That’s pretty spot on.

  • https://www.facebook.com/maggie.moore.68 Maggie Moore

    Probably a stroke, face palm. My life every shift

  • https://www.facebook.com/nursebananahammock Mel Hollis

    This is scary, because it could work.