Confusion et al

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Confusion Corner 20 female fever episode of confusion Asleep 40 yr old Eastern Creek, fully geared up, off 120kph Amnesic 79 yr old diabetic woman TIA Pleasantly confused 85 year old Gowned up, and leaving for “home”

Warning Signs associated with altered conscious state Early SignsLate Signs  Altered mentation  Unresponsive to verbal command  BSL 1-2.9mmol/L  GCS < or = 8  A drop in GSC of 2 points or more  BSL < 1 mmol/L  GCS<12  Any seizures

Delirium

Classic Mnemonic AEIOU TIPS A alcohol E endocrinopathy, encephalopathy, electrolytes I insulin Diabetes O oxygen, opiates U uraemia T Toxins I infection P psychogenic S seizure, syncope, space occupying lesion

Structural

Metabolic / Systemic

Assessment Blood Tests arterial blood gas/ glucose FBC, EUC, LFT, Clotting, TFT toxicology studies blood cultures Radiological Investigations CT Brain Remember it is unsafe to send a patient with an unprotected airway to the CT scan

Withdrawal from drugs and alcoholHyponatremia Wernicke’s Encephalopathy Haemorrhage (epidural, subdural, intracranial) and Head injury * HypoxiaInfection HypercapniaMeningitis/Encephalitis * HypotensionPoisoning Hypertensive EncephalopathyPain Hypoglycaemia, HyperglycaemiaSeizures * HypothermiaStroke* HypothyroidismSystem failure – cardiac, respiratory, liver, renal failure and endocrine Systemic vs intracranial*

Confused Geriatric Patient Treat with dignity Don’t be confrontational when communicating Get a relative to talk and listen Leave the light on Make sure they cant fall Don’t dismiss as “normal for them”

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