ams

2015 Guidelines for Altered Mental Status 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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  • Jimothy Dalton

    Most famous for his invention of the reflex, Jimothy Dalton is best characterized by his flippant demeanor and quizzical facial expressions. He is grateful for his Arkansan upbringing which painted his education wholly Creationist and fruitfully agrarian. Despite his frontal lobotomy, Jimothy remains gleefully productive in the fields of Netflix rentals, underwear modeling, and bouncy castles. When he isn’t writing for gomerblog, he’s dealing with patients. And thinking about what he’s going to write next for gomerblog.

  • Show Comments

  • Avatar
    Josh Lovinger

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

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    Josh Lovinger

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

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    Amy C. Hulton

    Psych is on the algorithm..

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    Rajnee Dhawan

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

  • Avatar
    Traci Kane Anderson

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

  • Avatar
    Angela Spencer

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

  • Avatar
    Diane Bockelman

    So good!

  • Avatar
    Doni Bernd-Phelps

    Pretty much…

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    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.

  • Avatar
    Kelly Averill

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

  • Avatar
    Haley Johnson

    Alex Josiah Dunn yes, yes we did

  • Avatar
    Anne Clinton

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

  • Avatar
    Angela R. Wooley

    Hummmm John Dempster can you translate?

  • Avatar
    Kathleen Sullivan Fierro

    Truth in satire!

  • Avatar
    Jim Seeman

    It all looks good to me!

  • Avatar
    Christina Holzwarth

    Ha!

  • Avatar
    David Weisman

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

  • Avatar
    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”

  • Avatar
    Brandi Anderson

    Brady Nutzman

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    Christie Shanafelt

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

  • Avatar
    Emily Schwartz Dewey
  • Avatar
    Christopher Wright

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

  • Avatar
    Brady Nutzman

    Brandi Anderson

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    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.

  • Avatar
    Alex Josiah Dunn

    Haley did we write this?

  • Avatar
    Colin Wetz

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

  • Avatar
    Heather Day

    Surprisingly accurate…

  • Avatar
    Jon Longoria

    Mohammad, Dustin, Nitish: LOL!

  • Avatar
    Christopher Wright

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

  • Avatar
    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.”

  • Avatar
    Michael Flamoe

    Matthew Thompson

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    Monica Airaf

    genius

  • Avatar
    Joanie Sapienza

    Hahahhahahahahhahaahahahhauahahauauauuauauaauauuauauwuwuwuwuwwuwuuwu!

  • Avatar
    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.

  • Avatar
    Gene-Paul Matson

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

  • Avatar
    Laura Rogan Young

    Lol!!

  • Avatar
    Elizabeth Purling

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

  • Avatar
    Jeff Chambers

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

  • Avatar
    Warren Carll

    Mark Omar Waheed

  • Avatar
    Melanie Nordlinger

    David Weisman Brad Klein

  • Avatar
    Kerri West

    Hahaha oh my. This is amazing.

  • Avatar
    Emma Costello

    Craig Costello

  • Avatar
    Hannah Hfr

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

  • Avatar
    Jennifer Kirsch

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

  • Avatar
    Rebecca Bakkestuen

    Terri McDaniel Todd

  • Avatar
    Brandy Daly

    Christian Basque George Rucco

  • Avatar
    Lora Ann Cullipher

    Lots of punting going on here.

  • Avatar
    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…

  • Avatar
    Andrea Collins Kelly

    That’s pretty spot on.

  • Avatar
    Maggie Moore

    Probably a stroke, face palm. My life every shift

  • Avatar
    Mel Hollis

    This is scary, because it could work.

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