2. Confusion Flashcards
What syndromes can cause confusion?
- Delirium
- dementia
- mental impairment
- psychosis
- dysphasia
What is delirium?
An acute impairment in cognitive ability together with impaired consciousness
What is dementia?
Chronic progressive cognitive impairment with intact consciousness
what is mental impairment?
a permanent impairment in cognitive ability.
what is psychosis?
- when the patient is hallucinating due to deranged personality and loss of contact with reality
what is receptive dysphasia?
- the patient might have difficulty understanding questions due to damage of Wernicke’s area of the breain
what is expressive dysphasia?
- when the patient is cognitively intact but has difficulty verbalising answers to questions
- damage to brocas area of the brain
examples of tests given to confused people?
- AMTS (6/10) - abbreviated mental test score
- MMSE (26/30) - mini mental state exam
- CAM - confusion assessment method
- MOCA - Montreal cognitive assessment
What are the components of AMTS?
- TIME
- What time is it?
- What year are we in?
- How old are you?
- SPACE
- What building are you in?
- PERSON
- Who am I? Who is that person (e.g nurse)?
- LONG TERM MEMORY
- What is your date of birth?
- What year did WW2 end?
- Who is the current PM?
- SHORT TERM MEMORY
- Please count from 20 to 1
- Can you remember the address I told you?
key questions to ask anyone accompanying the confused person?
- normal state? (might suggest dementia, psychosis, mental impairment)
- time course of confusion? ( acute and fluctuating suggests delirium)
- drug history ( important for dementia)
list of causes of delirium?
and the mnemonic?
- INVITED MD
- infectious
- neoplastic
- vascular - stroke
- immune - rare conditions such as neuropsychiatric lupus, Hashimoto’s encephalopathy
- trauma
- endocrine - thyroid disorders, diabetic ketoacidosis
- drugs
- metabolic - electrolyte disbalance
- degenerative - dementia predisposes delirium
What are infectious causes of confusion?
common: chest/ urinary infection
uncommon: encephalitis, brain abscess, sepsis)
What are neoplastic causes of confusion?
brain tumour
What are traumatic causes of confusion?
Subdural haematoma
What drugs may cause confusion?
- Diuretics, digoxin, thyroid medication
what vital signs should be monitored and why?
- pulse and resp rate: suggests infection
- blood pressure: might suggests hypoperfusion of the brain
- oxygen saturation: suggests hypoxia
- temp: suggests fever therefore infection
- blood glucose: hypo/hyperglycemia can affect consciousness
What are some of the signs of sepsis on examination?
- Chest- bronchial breathing (infection)
- Urine- suprapubic tenderness
- Cellulitis - inspect the skin for infection
- Meningitis- neck stiffness, photophobia, and purpuric rash
how to assess consciousness?
- Glasgow coma scale
- this assesses motor, verbal and eye responses
- lowest score is 3 = coma
- highest score is 15
a score lower than or equal to 8 suggests the patient cannot protect their own airway so needs to be intubated
further things to examine in confused patients?
- pupils (can suggest overdose)
- Focal neurological signs (suggesting stroke or a space-occupying lesion)
- Needle track marks: suggests intravenous (IV) drug abuse.
- Cherry red lips: occurs in carbon monoxide poisoning
- Asterixis: hypercapnia
- bitten tongue: suggests convulsive seizure
What investigations may you request for someone who presented with confusion?
- Septic screen: (FBC, CRP, blood cultures. urine dipstick, chest xray,)
- Metabolic screen (blood gas, Us and Es, Thyroid function test, liver enzymes, thiamine, folate, and vit.B)
- ECG
how to manage confusion?
- ensure patients are attended
- make sure they have glasses and hearing aids
- discontinue non-essential medication causing confusion
- provide fluids and nutrition
- as final resort sedation might be necessary
- haloperidol may be used 30-60 mins onset
- lorazepam could be used 5-10 mins onset
treat the CAUSE!!
