Quote from Mikai on October 4, 2025, 5:11 pm

Patient 81 years come with confusion , approach?

Mikai return ..

Initial Assessment:

• Vital Signs: Check blood pressure, heartrate, oxygen saturation, andtemperature. - Mental Status: Assesslevel of consciousness, orientation, andcognitive function using tools like theAMTS (Abbreviated Mental Test Score)or MOCA (Montreal CognitiveAssessment). - Neurological Exam:Evaluate for focal deficits (e.g.,hemiparesis, aphasia, neglect) to ruleout stroke or other neurological causes.- Key Questions:
• Onset and duration of confusion. -Recent falls, head trauma, or infections(e.g., UTI, pneumonia). - Medicationreview (e.g., sedatives, anticholinergics,opioids). - History of dementia, stroke,or other chronic conditions. -Immediate Investigations:
• Blood Tests: CBC, electrolytes, glucose,renal function, calcium, TSH, andpossibly troponin if cardiac causesuspected. - Urinalysis: To rule outurinary tract infection (UTI). - Imaging:Non-contrast CT head to exclude stroke,hemorrhage, or mass lesions. - ECG: Toassess for arrhythmias or ischemia. -Differential Diagnosis:
• Delirium: Common in elderly, often dueto infection, metabolic derangements,or medications. - Dementia: If confusionis chronic or progressive; considerAlzheimer’s, vascular dementia. -Stroke/TIA: Acute focal deficits withsudden onset. - Sepsis/Infection:Systemic illness (e.g., pneumonia, UTI). -Metabolic Causes: Hypoglycemia,hyponatremia, uremia. - Management:
• Delirium: Address reversible causes(e.g., treat infection, discontinueoffending drugs). Ensure orientation,minimize sensory overload, and uselow-dose antipsychotics if agitated(e.g., haloperidol). - Stroke: If confirmed,follow stroke protocol (e.g., thrombolysisif within window, neuroimaging,neurology consult). - Infection: Startempiric antibiotics if UTI or pneumoniasuspected; culture and sensitivities. -Metabolic: Correct imbalances (e.g.,rehydrate, replace electrolytes). -Rationale: Confusion in the elderly isoften multifactorial. Rapid assessmentand targeted investigations are crucial