Paramedic Student Nurse

[medic2nurse]

I have a question for anyone who is willing I read in a text once that there was a particular set of assays reviewed to rule out possible Nuero or Endo related syndromes masquerading as psych...any ideas? I read this posts often...last semester of RN school...I am feeling a mental fugue on the minor details....any direction would be great

[cougarnurse]

Ya know....one of the other Admin's might be able to help. When he's able, he'll be able to answer you.

[medic2nurse]

thanks!

[Ricu]

If only it were that simple. I never heard of a specific set of lab tests for determining whether a patient has true organic disease or psychiatric. My sense is that each patient's conditions have to be isolated separately.

I will tell a somewhat relevent story here of a case where one condition looked like another. While working on a telemetry unit, I had a patient who came in early for an elective cardiac cath and fifteen minutes into the admission database, she had a sudden onset of garbled speech and right-sided weakness. We did the STAT workup and thankfully, labs came back before we got the CT and we learned that her glucose was 20. Following doctor's orders, she remained NPO but did take her meds- including her insulin. Maybe she should've taken a sip of pancake syrup with her pills instead of water, huh? Moral of the story: Extreme hypoglycemia can look like a TIA or stroke so in that setting, immediately do a FSBS if you have the equipment available. Because of the AHA stroke awareness campaign this may be considered common knowledge now but fifteen years ago when my previously aniimated patient started melting right before my eyes, it wasn't.

R

[Robert F]

I have a question for anyone who is willing I read in a text once that there was a particular set of assays reviewed to rule out possible Nuero or Endo related syndromes masquerading as psych...any ideas? I read this posts often...last semester of RN school...I am feeling a mental fugue on the minor details....any direction would be great

Could you link me to the literature? I would be more than happy to help if I am able. Well, you have several chemical mechanisms and neuro-transmitters to be concerned about, such as N-methyl-D-Aspartate receptor antagonists, Dopamine, Serotonin, and secondary injury. However, I am aware of no specific test that can do what you are speaking of.

You can do the Halo Test to check for CSF leaking, Assess AVPU and GCS, look for signs of epidural hematoma (classic hallmark: Lucid interval period), however an MRI or CAT scan would be the ideal way to rule out head injury. Furthermore the first steps in the diagnosis of mental disorders in the five Axis diagnosis system as defined by the DSM-IV is to rule out medical conditions, mental retardation, and environmental factors.