1. Confusion et al

5. =

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

8. 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

9. Delirium

10. 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

11. Structural

12. Metabolic / Systemic

14. 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

16. 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*

18. 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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