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Confusion

Confusion. Neil Barnard – A&E Registrar. Confusion is … confusing. Some definitions: CONFUSION: Misinterpretation of surroundings or bewilderment DELERIUM: A fluctuating level of consciousness of rapid onset with global disturbance of cognition (memory, language, orientation)

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Confusion

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  1. Confusion Neil Barnard – A&E Registrar

  2. Confusion is … confusing Some definitions: CONFUSION: Misinterpretation of surroundings or bewilderment DELERIUM: A fluctuating level of consciousness of rapid onset with global disturbance of cognition (memory, language, orientation) DEMENTIA: An acquired, progressive decline in intellectual behaviour and personality. It is irreversible and is usually associated with a normal level of consciousness CONSCIOUSNESS: Wakefulness with awareness of self and surroundings

  3. So, what causes confusion? D rugs O xygen P sychiatric disturbance E lectrolyte S eizure V ascular O rgan failure M etabolic derangement I nfection T rauma E ndocrine D extrose

  4. Approach in the A&E? SAFETY ABC HISTORY EXAMINATION INVESTIGATIONS FINAL DISPOSITION

  5. History Source? Important features Time of onset Rapidity of evolution Previous episodes Previous medical conditions

  6. Examination THROUGH AND COMPREHENSIVE! General features Level of consciousness, Hydration, Wasting, Signs of organ failure, Smell Neuro Lateralising signs? Dysarthria, incoordination, Pupillary dysfunction Chest Hypoxia? Abnormal respiratory pattern? Infections? CVS Signs of faliure, dysrhythmia Abdo Intra-abdo sepsis? Ischaemic bowel? Renal Urine

  7. Investigations? Driven by history and examination findings: Always get a glucose, urine Other pathology? FBC U/E LFT Calcium ABG TSH LP Imaging? CXR ECG CT

  8. Is this psychiatric?

  9. Initial treatment/Disposition? Depends on diagnosis Treat immediate life threats first Refer to appropriate in patient service If in doubt, admit, observe. May need to invoke MHA/MCA At time of discharge, ensure appropriate follow up

  10. Questions

  11. Take home messages Ensure your and the patient’s safety Assess and manage ABC’s 1st Have a broad differential and examine thoroughly Seek senior input early If in doubt, admit, observe Ensure appropriate post discharge follow up

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