Acute assessment of new onset confusion (delirium)

A medical consult is recommended where there is no specific protocol for a condition
  • Always consider sepsis — signs and symptoms can include
    • High or low temperature
    • Fast breathing
    • Fast pulse
    • Low BP or dizziness
    • Confusion and/or agitation
  • Acute confusion (delirium) is a medical emergency — increased mortality and injury — urgent medical consult
  • Key features — rapid onset, fluctuating altered level of consciousness (drifting or unable to reliably follow commands), impaired communication, disorientation, altered vital signs
  • There are 3 types of delirium
    • Hyperactive delirium — agitation
    • Hypoactive delirium — patient is withdrawn, mute and drowsy
    • Mixed delirium — periods of hyperactive delirium and hypoactive delirium
  • Pre-existing dementia or psychosis can mask an acute delirium — careful assessment is required in these patients

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • If REWS score 3 or more — urgent medical consult
  • If available POC Test — WBC, electrolytes
  • U/A, pregnancy test 
  • History, especially medications — taking lots, the wrong way or new medicine
  • Head-to-toe exam

Table 1.9 Some causes of acute confusion (delirium)