Confusion, Acute
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 ***Alert/Verbal Stimulus Response/Painful Stimulus Response/Unresponsive***
Delirium elements (needs to have all 4) ***Disturbance of consciousness (i.e., reduced clarity of awareness about the environment) with reduced ability to focus, sustain, or shift attention./A change in cognition (e.g., memory deficit, disorientation, language disturbance) or development of a perceptual disturbance that is not better accounted for by a preexisting, established, or 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 from the history, physical examination, or laboratory findings indicate 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: = 2[Na+] + [Glucose]/18 + [ BUN ]/2.8 where [Glucose] and [BUN] are measured in mg/dL.)/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***

Result - Copy and paste this output: