altered mental status

DC Inst – Peds CHI

DC, Peds

MALE CHILD:
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Your son has been evaluated in the Emergency Department today for his head injury. It is possible that your son has had a minor concussion tonight. Typical symptoms after a concussion include headache, some nausea, and difficulty concentrating. If these symptoms worsen or become severe, bring your son back to the ER.

He should avoid contact contact sports, strenuous exercise, or extended computer use for the next few days, until he is feeling completely well again.

Please follow up with your son’s pediatrician within three days.

Return to the Emergency Department if your son experiences severe headache, vision changes, recurrent vomiting, difficulty with normal activities, lethargy, abnormal behavior, difficulty walking, numbness, weakness, or any other concerning symptoms.

Thank you for choosing us for your son’s care.

FEMALE CHILD:
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Your daughter has been evaluated in the Emergency Department today for her head injury. It is possible that your daughter has had a minor concussion tonight. Typical symptoms after a concussion include headache, some nausea, and difficulty concentrating. If these symptoms worsen or become severe, bring your daughter back to the ER.

She should avoid contact contact sports, strenuous exercise, or extended computer use for the next few days, until she is feeling completely well again.

Please follow up with your daughter’s pediatrician within three days.

Return to the Emergency Department if your daughter experiences severe headache, vision changes, recurrent vomiting, difficulty with normal activities, lethargy, abnormal behavior, difficulty walking, numbness, weakness, or any other concerning symptoms.

Thank you for choosing us for your daughter’s care.

DC Inst: Altered Mental Status

DC

You have been evaluated in the Emergency Department today for a period of altered mental status. Your evaluation, including lab work and imaging of your brain, did not show evidence of conditions requiring further emergent medical intervention at this time.

Please schedule an appointment as soon as possible with your primary care physician for follow up.

Return to the Emergency Department if you experience worsening periods of confusion, loss of consciousness, numbness/tingling, weakness, trouble speaking, vision changes, chest pain, shortness of breath, or any other worsening symptoms.

Thank you for choosing us for your care.

AMS – Hepatic Encephalopathy

MDM

This is a @AGE@ @SEX@ with a presentation consistent with acute hepatic encephalopathy. Exam notable for stigmata of cirrhosis and portal hypertension. Likely precipitant: increased ammonia levels (GIB // excess protein // infection // electrolyte and/or acid base disturbance// constipation) // dehydration (vomiting, diuretic use) // medication induced (opioids, benzodiazepine overdose or withdrawal // ETOH use.*** Low suspicion for acute GIB, including evidence of life threatening hemorrhage. Low suspicion for acute infection including SBP (no fevers, abdominal pain). Presentation not consistent with other acute, emergent causes of altered mental status (including but not limited to renal failure, ICH) at this time.

Plan: labs, LFTs, ammonia level, PT/INR, UA, CXR, CT brain***, diagnostic paracentesis***, serial reassessment

Altered Mental Status – General

MDM

This is a @AGE@ @GENDER@ presenting with altered mental status, concerning for ***. The differential includes toxic metabolic etiologies such as electrolyte disturbances (Na/Ca), hypoglycemia, and uremia; acidosis states, infection (i.e. Sepsis); toxidromes of intoxication or withdrawal, hypoxemia or hypercarbia, liver disease or failure causing hepatic encephalopathy, endocrine emergencies (hyper/hypothyroidism, adrenal insufficiency), seizure, trauma, intracranial bleeds or ischemic stroke. Given this wide differential, will send basic labs and lytes to evaluate for metabolic causes, FSBS, LFTs,, TSH, ***CT head, ***blood gas. ***LP?/abx?