Confusion Flashcards
What syndromes can cause a patient to appear ‘confused’?
Delirium: an acute impairment in cognitive ability together with impaired consciousness.
Dementia: a chronic, progressive impairment in cognitive ability but with
intact consciousness. Note that this is different from delirium and that you
cannot diagnose dementia from a single mental status assessment.
Mental impairment: a permanent impairment in cognitive ability.
Psychosis: the patient may not be confused, but hallucinating or deluded due to a deranged personality and loss of contact with reality.
Receptive dysphasia: the patient may have difficulties comprehending your questions (e.g. due to damage to Wernicke’s area of the brain).
Expressive dysphasia: the patient may be cognitively intact but have difficulties
verbalizing an answer to your questions (e.g. due to damage to Broca’s area
of the brain).
Mr Hext is a 65-year-old man who is found to be confused on the ward round the day after resection of his colorectal cancer. His observations and investigations prior to the operation were all normal. There are no signs of infection on inspection of the wound site and he does not look or feel hot or sweaty. His peripheral pulses are present (if a little weak), lung fi elds are clear, there are no heart murmurs (to suggest
endocarditis), and no obvious signs of infection elsewhere. He is not connected to a pulse oximeter, ECG, or blood pressure monitor so you ask for this to be done, and also order some investigations.
Possible causes?
Hypoxia
Opiates
Electrolytes
Infection
Sleep loss
Mr Burns is a 44-year-old man on the cardiac care unit who becomes confused and aggressive 4 days after suffering a myocardial infarction. Looking at his notes, you find nothing unusual in his observations (pulse, blood pressure, temperature, blood glucose, oxygen saturation), drug history, or blood tests (including inflammatory markers, electrolytes, and liver function). However, you see in his initial clerking that he admitted to drinking 50–60 units a week and has a history of alcoholism
Most likely diagnosis and treatment?
Alcohol withdrawal
Thiamine and chlordiazepoxide
