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Acute confusion – Patient assessment and diagnosis of cause

Acute confusion – Patient assessment and diagnosis of cause. Mr Rob Simpson ED Consultant UHCW. Acute confusion. Definition Abreviated mental test (AMT) Causes interactive Patient assessment (a practical approach) Interactive Summary & close. Acute confusion - definition.

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Acute confusion – Patient assessment and diagnosis of cause

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  1. Acute confusion – Patient assessment and diagnosis of cause Mr Rob Simpson ED Consultant UHCW

  2. Acute confusion • Definition • Abreviated mental test (AMT) • Causes • interactive • Patient assessment (a practical approach) • Interactive • Summary & close

  3. Acute confusion - definition • There are several medical definitions of delirium (including those in the DSM-IV and ICD-10). However, all include some core features. • The core features are: Disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention) • Change in cognition (e.g., problem-solving impairment or memory impairment) or a perceptual disturbance • Onset of hours to days, and tendency to fluctuate. • Common features also tend to include: • Intrusive abnormalities of awareness and affect, such as hallucinations or inappropriate emotional states

  4. Abbreviated mental test (AMT) • Abbreviated mental test score • 1. Age ? • 2. Time? (to nearest hour) • 3. Address for recall at end of test(this should be repeated by the patient to ensure it has been heard correctly): "42 West Street“ • 4. Year? • 5. Name of this place? • 6. Identification of two persons (doctor, nurse etc.)? • 7. Date of birth? • 8. Year of First World War? • 9. Name of present Monarch? • 10. Count backwards 20 to 1 Address recall correct?

  5. Abreviated mental test score = /10 • Should score 7 or more out of 10 • Score of 6 or less suggests delirium or dementia

  6. About / problems • Developed by geriatricians in 1972 • Not validated for primary care or screening tool • Some cultural validity issues • Sensitivity: 70-80% • Specificity: 71-90% • (at 7-8 cut-off)

  7. Causes of acute confusion • DIBBS pnemonic • Drugs • Infection • Biochemical • Bladder • Surroundings • For each consider common and less common causes

  8. Approach to the confused patient • Rapid tranquilisation ? • Capacity / best interests ? • Assessment • History ? • Examination • Bloods • Notes and drug chart • Other investigations

  9. Summary & Close • Acute confusion is VERY common • Need a robust and practiced approach to secure the underlying cause (DIBBS) • Common things are common • Having diagnosed the cause – remove it or treat it!

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