Episode 12 - Altered Mental Status

Vitals & Useful Links:

• Learn about an important etiology of Altered Mental Status. See spoilers below if you want to know which one.
• Podcast: Approach to Altered Mental Status - EM Clerkship Podcast
• Clinical Reference: CDEM M4 Curriculum - Altered Mental Status

This week Jordan is still with us to teach us some critical care medicine. Jordan is an EM intern who joins us to lead Kyle (MS4) and Arman (MS4) through a case of a woman who is brought to the hospital for altered mental status. How would you approach this case? As always, we learn a couple very important points about evaluating and treating AMS. If you have any questions, concerns, or comments, please email us at emjccast@gmail.com.

*EPISODE SPOILERS BELOW*

Jordan's Article on Rapid BP Lowering in Acute ICH

Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, Hata J, Arima H, Parsons M, Li Y, Wang J, Heritier S, Li Q, Woodward M, Simes RJ, Davis SM, Chalmers J; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013 Jun 20;368(25):2355-65. doi: 10.1056/NEJMoa1214609. Epub 2013 May 29. PMID: 23713578.

Intensive BP Lowering in Acute Cerebral Hemorrhage

Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016 Sep 15;375(11):1033-43. doi: 10.1056/NEJMoa1603460. Epub 2016 Jun 8. PMID: 27276234; PMCID: PMC5345109.

Frequency of Inverted T-Waves in Acute Strokes (Cerebral T-Waves)

Stone, J., Mor-Avi, V., Ardelt, A., & Lang, R. M. (2018). Frequency of inverted electrocardiographic T waves (cerebral T waves) in patients with acute strokes and their relation to left ventricular wall motion abnormalities. The American Journal of Cardiology, 121(1), 120-124.

EMDocs: ICH ECG Pointers

Check out this site for a great case that walks through some of the pathophysiology of ICH as well as a discussion on Cerebral T-Waves

DISCLAIMER:
The views/opinions expressed in this podcast are that of the hosts/guests and do not reflect their respective institutions. This is NOT a medical advice podcast, if you are having a medical emergency you should call 911 and get help. This is an educational podcast, and as such, sometimes we get things wrong - if you notice this, please email us at emjccast@gmail.com.

Intro Music: "Walk Through the Park" by Track Tribe