Acute Confusion (OSCE)
History Taking for the Onset of Acute Confusion
Major and Minor Criteria
[edit | edit source]- diagnosis of delirium requires both major plus any one minor criteria
- Can remember the criteria using the mnemonic AIDS:
Major
[edit | edit source]- Acute onset and fluctuating course
- Disorder of attention (inattention)
Minor
[edit | edit source]- Disorganized thinking
- Alterations in sensorium (e.g. visual or auditory hallucinations)
Patient ID
[edit | edit source]CC
[edit | edit source]- need several iterations of the history, from several caregivers (may have large inter-observer differences in opinion)
HPI
[edit | edit source]- 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 | edit source]- benzodiazepines
- beta-blockers
- anticholinergics
PMHx
[edit | edit source]- trauma
- stroke
- CAD
- endocrinopathy
- kidney
- psych
FMHx
[edit | edit source]- dementia
- depression
SHx
[edit | edit source]- EtOH
- social support (caregiver stress), living arrangements
ROS
[edit | edit source]- sleep pattern
- visual changes
- hearing loss
- constipation
- incontinence