Neurological Emergencies—Acute Mental Status Change
Acute mental status changes in a hospitalized patient
What is going on?
Realize that the same history of acute mental status change could have been given
in the context of:
- our spinal cord injured patient: you get called saying this drunk C-spine injury is DT'-ing, give me an order for Valium
- our Guillain-Barre patient: you get called saying this GBS quad is having acute unit psychosis, give me an order for some thorazine
But something makes you hesistate. God bless instincts...
What thread is running through all these cases?
When you think of it, each of these three patients has a very good reason to be HYPOXIC.
- the hip replacement lady could have just had a large PE
- the Cspine injury man could be swelling up his cord to hit his phrenic nerve axons at C345
- the GBS patient could be ascending to knock out the phrenic nerves
You must presume that acute mental status changes are hypoxia until proven otherwise.
So go up there, get a pulse-oximeter and an ABG, and think of how this patient could be trying to die on you right there. Patients, kind souls that they are, have a tendency to try to die on you when you are least expecting it, so develop the habit of wariness in your clinical practice. It doesn't matter how many years you have walked next to the edge of a cliff: your next step could put you over the side.
