意識不清與昏迷

Altered Mental Status and Coma from Sun YaiCheng

意識不清與昏迷
Altered Mental Status (AMS) and Coma

Mnemonic for Treatable Causes of AMS (AEIOU-TIPS)

• A Alcohol
• E Endocrine, Electrolytes, Encephalopathy
• I  Insulin
• O O2, Opiates
• U Uremia

• T Trauma
• I  Infection, Intra-cranial
• P Poisoning
• S Seizure, Stroke, Sepsis, Shock

Reversible cause of AMS

• Hypoglycemia, narcotic overdose, hypoxia, hypercarbia should be quickly investigation and treatment

• If structural lesion etiology is indicated → non-contrast head CT

Delirium

Diffuse metabolic and multifocal cerebral lesion, generalized impairment of brain functions or at least a bilateral involvement limbic structure

Major brainstem reflexes used in coma examination

• oculocephalic reflex
• pupillary light reflex
• corneal reflex
• oculovestiblar reflex
• gag reflex
• apnea test

Adapted from Rosen's Emergency Medicine, 7E
Chapter 14 Depressed Consciousness and Coma

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