M&M - EM Chiefs

Change in Mental Status and Abnormal Laughter

•  Consider non-convulsive status epilepticus in the patient with altered mental status and no other explanation.
  
•  A trial of benzodiazepene may help distinguish seizure from other causes of AMS.

---

---

Abdominal Pain in Pt who has MS and Drinks Everyday

• Gastric Perforation
• Time to surgical correction is important... delays in diagnosis need to be avoided.
• Don't allow a "difficult" patient and your altered work flow affect your concern for potential badness.
• Sign Outs can be hazardous for everyone involved!

---

---

Change in Mental Status

• Keep Basilar Artery Stroke on your list for pt with Change in MS
• Look closely at the non-contrast Head CT for Hyperdense Basilar Artery Sign
• 71% sensitive and 98% specific
• Always look at the Basilar Artery!

---

---

Pupura on Ears of Pt

• Levamisole Induced Vasculitis
• Ask patients about history of cocaine abuse.
• ~70% of the US cocaine is cut with levamisole (adds bulk and may potentiate stimulant effect).
• Supportive care... and stop cocaine. If abuse continues, can lead to necrosis.

---