, 1. Initial Assessment (ABCs & Vital Signs)
• Airway, Breathing, Circulation – stable?
• Obtain vitals: BP, HR, RR, O₂ sat, temperature.
• Fingerstick glucose – hypoglycemia is a common reversible cause of acute confusion.
2. Focused History (from family/EMS if patient is confused)
• Onset: Sudden vs. gradual?
• Associated symptoms: Fever, headache, weakness, seizure-like activity, incontinence?
• Medications: Any new meds, insulin, anticholinergics, benzodiazepines, opioids?
• Past medical history: Diabetes, hypertension, dementia, prior strokes, psychiatric
illness?
• Social history: Alcohol use, possible exposure to toxins/carbon monoxide?
• Last known well time.
3. Differential Diagnosis (broad for acute confusion in a 55-year-old)
• Metabolic: Hypoglycemia, hyponatremia, hypercalcemia, uremia, thyroid disorder
• Infectious: UTI (especially in older females), pneumonia, meningitis/encephalitis, sepsis
• Neurologic: Stroke (ischemic/hemorrhagic), seizure (postictal), subdural hematoma
• Toxicologic: Medication side effects, alcohol intoxication/withdrawal, illicit drugs
• Structural: Hydrocephalus, mass lesion
• Other: Delirium from any acute illness, hypoxia, carbon monoxide poisoning
4. Initial Workup (with full lab & imaging available)
Labs:
• CBC, BMP (electrolytes, BUN, creatinine, glucose)
• Liver function tests, ammonia level
• TSH
• Urinalysis (with reflex culture)
• Blood cultures (if fever or suspicion of sepsis)
• Toxicology screen (serum/urine)
• Lactate
• Airway, Breathing, Circulation – stable?
• Obtain vitals: BP, HR, RR, O₂ sat, temperature.
• Fingerstick glucose – hypoglycemia is a common reversible cause of acute confusion.
2. Focused History (from family/EMS if patient is confused)
• Onset: Sudden vs. gradual?
• Associated symptoms: Fever, headache, weakness, seizure-like activity, incontinence?
• Medications: Any new meds, insulin, anticholinergics, benzodiazepines, opioids?
• Past medical history: Diabetes, hypertension, dementia, prior strokes, psychiatric
illness?
• Social history: Alcohol use, possible exposure to toxins/carbon monoxide?
• Last known well time.
3. Differential Diagnosis (broad for acute confusion in a 55-year-old)
• Metabolic: Hypoglycemia, hyponatremia, hypercalcemia, uremia, thyroid disorder
• Infectious: UTI (especially in older females), pneumonia, meningitis/encephalitis, sepsis
• Neurologic: Stroke (ischemic/hemorrhagic), seizure (postictal), subdural hematoma
• Toxicologic: Medication side effects, alcohol intoxication/withdrawal, illicit drugs
• Structural: Hydrocephalus, mass lesion
• Other: Delirium from any acute illness, hypoxia, carbon monoxide poisoning
4. Initial Workup (with full lab & imaging available)
Labs:
• CBC, BMP (electrolytes, BUN, creatinine, glucose)
• Liver function tests, ammonia level
• TSH
• Urinalysis (with reflex culture)
• Blood cultures (if fever or suspicion of sepsis)
• Toxicology screen (serum/urine)
• Lactate
