Rule out medical pathology as cause or exacerbating factor for presentation
Point-of-care glucose
CBC
Chem 7
LFTs
ECG (for toxicology evaluation)
ASA level
Tylenol level
Urine toxicology screen/Blood toxicology screen
EtOH
Urine pregnancy/beta-hCG (if female of childbearing age)
Consider:
Ammonia (see Hepatic encephalopathy)
TSH (hypo or hyperthyroidism may mimic mental illness)
CXR (for Tb screen or rule-out delirium in older patient)
UA (for rule-out delirium in older patients)
Head CT (to rule-out ICH in patients with AMS)
Lumbar puncture (to rule-out meningitis or encephalitis)
Ammonia (see Hepatic encephalopathy)
TSH (hypo or hyperthyroidism may mimic mental illness)
CXR (for Tb screen or rule-out delirium in older patient)
UA (for rule-out delirium in older patients)
Head CT (to rule-out ICH in patients with AMS)
Lumbar puncture (to rule-out meningitis or encephalitis)
Sad person's score
Class B recommendations
Routine laboratory testing is of low yield and unnecessary
Routine urine toxicology need not be performed
Pending results should not delay transfer or evaluation
Patient’s cognitive abilities, rather than specific blood alcohol level, should dictate initiation of psychiatry evaluation
General psychiatric approach
Organic causes
Opioid free regimens
Delirium
General Approach to EM Geriatrics
Dementia
Antipsychotics
Overdose