Acute confusion

Question 1

What is the ‘Act FAST’ campaign for TIA/Stroke?

Answer 1

F- Facial drooping; unilaterally usually
A- Arms, are the working?
S- Speech; is it slurred or is the person unable to talk at all?
T- Time; phone 999 if there are any of these symptoms present

Question 2

How is delirium characterised?

Answer 2

Acute onset of disturbed consciousness, cognitive function or perception, with a fluctuating course. It usually develops quickly over the space of a few days.

Question 3

List 5 out of 14 causes of delirium.

Answer 3

1. Acute infection; UTI most common in the elderly
2. Prescribed drugs
3. Surgical
4. Toxic substances; alcohol, CO, illicit drugs
5. Vascular disorders; haemorrhage (subdural or subarachnoid), cardiac failure etc
6. Metabolic causes
7. Vitamin deficiency
8. Endocrinopathies
9. Trauma
10. Epilepsey
11. Neoplasia
12. Urinary retention
13. Faecal impaction
14. Multiple or unknown

Question 4

How should we approach a patient who is delirious?

Answer 4

Perform a systematic review, asking questions to rule things out as well as rule them in.

Question 5

What is a Lasting Power of Attorney (LPA)?

Answer 5

A legal document that allows an individual (donor) to appoint one or more people (attorneys) to help make decisions or to make decisions on the donor’s behalf in the future if they begin to lack mental capacity.

Question 6

What are the 2 types of LPA?

Answer 6

1. Health and welfare

2. Property and financial affairs

Question 7

What is an ‘Advanced Care Plan’?

Answer 7

A written statement, from the patient, setting out preferences, wishes, beliefs and values regarding future care, to provide a guide for anyone who might have to make decisions in the patient’s best interest in the future. This is not legally binding.

Question 8

What is an ‘Advanced Decision’?

Answer 8

A decision a patient with capacity can make to refuse specific treatments in the future. This is a legally binding document, as long as it meets the necessary criteria for it to be considered valid and applicable.

Question 9

Which medications commonly cause hyponatraemia (low sodium)?

Answer 9

• ACE-I
• Diuretics
• Anti-depressants
• PPI’s

Question 10

What is a worrying condition that can cause hyponatraemia?

Answer 10

Non-small cell lung cancer that can cause syndrome of inappropriate ADH production (SIADH)