ALiEM - By Christina Shenvi MD, PhD | August 1st, 2013
..."As EPs we are trained to think of a ‘worst first’ differential diagnosis. However, this approach becomes challenging when the chief complaint is as broad as AMS, which could be applied to someone experiencing a devastating intracranial hemorrhage or –alternatively- to someone who was labeled “unresponsive” at their nursing facility because they had fallen asleep. In an altered patient, it is difficult to weigh which of the many potential maladies could be worst (urosepsis? MI? stroke? ICH?). So it is not always clear where to start. Obtaining more history and performing a physical will usually be helpful to narrow your differential so that you can focus your efforts. However, a time-based approach can also be helpful, especially when you are unable to obtain a history due to AMS, dementia, or a lack of available care-givers who can supply the history."
http://academiclifeinem.com/a-time-based-approach-to-elderly-patients-with-altered-mental-status/
También te podría interesar: