Altered Mental Status/Sharing an Approach to Deliberate Practice of Clinical Reasoning

Here is the PPT on the noon conference: Approach and Evaluation of the Patient with Altered Mental Status.

I’ve shared the classic MIST framework and MIST-negative framework. The MIST-negative framework contains a separate schema that expands on rapidly progressive dementia/CSF pleocytosis/intrinsic brain disease that would include some of the less common diagnoses.

I am learning that getting comfortable with “AMS” is not something one could achieve overnight (unlike Blood Gas Analysis). Instead, it requires a lot of deliberate practice. While building a case log of “AMS” to share below, I found out that Human Dx offers a perfect venue for deliberate practice: You can simply search a key word like “altered mental status”, pull up all the cases with a chief complaint of “AMS”, and crack them one by one to get different flavors of “AMS” in one day! (Remember to consistently practice/refine your Ddx framework while you do these exercises.)

Case Log of Altered Mental Status:

A 64-Year-Old Woman with Cognitive Impairment, Headache, and Memory Loss (NEJM Case records)

Confused about Confusion (NEJM Clinical Problem Solving)

… (to be continued) (dozens on Human Dx)