Acute Confusion (OSCE)

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History Taking for the Onset of Acute Confusion

Major and Minor Criteria[edit]

  • diagnosis of delirium requires both major plus any one minor criteria
  • Can remember the criteria using the pneumonic AIDS:

Major[edit]

  • Acute onset and fluctuating course
  • Disorder of attention (inattention)

Minor[edit]

  • Disorganized thinking
  • Alterations in sensorium (e.g. visual or auditory hallucinations)

Patient ID[edit]

CC[edit]

  • need several iterations of the history, from several caregivers (may have large inter-observer differences in opinion)

HPI[edit]

  • onset
    • acute (<2-3 months)
    • chronic (> 3 months represents a dementing state)
  • progress
    • gradual decline, static, rate of fluctuation
  • palliating
  • precipitating
  • quality
    • AIDS
    • altered LOC
    • disorientation
    • memory
    • psychomotor agitation/retardation
    • altered sleep-wake cycle
  • severity
    • ADL → getting out of bed, using the bathroom, dressing, ambulation
    • IADL → cooking, laundry, shopping, banking, paying bills, driving
    • safety concerns
    • cognitive function (MMSE)
  • symptoms
    • behaviour changes - agitation
    • SAH → thunderclap headache
  • stroke → aphasia, paralysis
  • UTI → dysuria
  • pneumonia → cyanosis, cough, sputum, fever

Medications[edit]

  • benzodiazepines
  • beta-blockers
  • anticholinergics

PMHx[edit]

  • trauma
  • stroke
  • CAD
  • endocrinopathy
  • kidney
  • psych

FMHx[edit]

  • dementia
  • depression

SHx[edit]

  • EtOH
  • social support (caregiver stress), living arrangements

ROS[edit]

  • sleep pattern
  • visual changes
  • hearing loss
  • constipation
  • incontinence

Other OSCE Modules[edit]