Confusion Plan

Apr 21, 2010 • Mark Morgan

categories: Assessment & Plan Geriatrics & Longevity

Acute management:
Intravenous Access Oxygen Delivery C-Spine immobilization (for suspected trauma) Dextrose (Suspected Hypoglycemia, bedside Glucometer first if possible): Adult: 50 ml of D50 IV, Child: 4 ml kg D25 (0.5-1.0 g/kg) IV Flumazenil (Suspected Benzo Overdose): Flumazenil 0.2 - 1.0 mg IV Naloxone (Suspected Narcotic Overdose): Adult: 2-4 mg IV, Child: 0.1 mg/kg IV Thiamine (Suspected Wernicke's Encephalopathy): Adult: 100 mg IV, Child: 10-25 mg IV Monitoring and redirection as needed Other

Evaluation:
Vital signs including pulse oximetry significant for
Blood pressure: Systolic Blood Pressure <90: Brain Lesion unlikely Systolic Blood Pressure >170: Brain Lesion likely
Level of consciousness

Delirium elements needs to have all 4. consciousness: 'clarity of awareness about the environment.' cognition: 'memory, orientation, language.'
Disturbance of consciousness with reduced ability to focus/sustain/shift attention. A change in cognition or development of a perceptual disturbance not better accounted for by a preexisting/established/evolving dementia. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of a day. Evidence that the disturbance is caused by direct physiologic consequences of a general medical condition.

Diagnostic evaluation: point of care glucose urinalysis CBC Chemistry panel Liver Enzymes Serum Osmolarity (calculated: Serum Calcium Serum Magnesium Urine Tox Screen Directed drug levels Arterial Blood Gas Rapid Plasmin Reagin (RPR) Thyroid Stimulating Hormone (TSH) Electrocardiogram (EKG) and/or cardiac monitor Head CT Lumbar Puncture C-Spine films (if trauma suspected) Chest XRay HIV Test Heavy metal screen Vitamin B12 Level Serum Folate Level

Confusion Plan

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