Introduction
- Wash hands
- Introduce self
- Ask Patient’s and relative’s names
- Explain the need for a collateral history
- Establish their relation to the patient
Presenting complaint
History of presenting complaint
- Onset: determine if it is acute, chronic, or acute-on-chronic (establish baseline function and cognition)
- Progression: slowly progressive (Alzheimer’s), step-like (vascular)
- Triggers: infection, stress
- Associated symptoms
- Depression
- Psychiatric symptoms: hallucinations/delusions
- Behavioural change: agitation, aggression, wandering, disinhibition, calling out
- Sleeping pattern: awake at night (Alzheimer’s), early morning waking (depression), fluctuating consciousness (delirium)
- Cognitive disturbances: aphasia, apraxia, agnosia, difficulty planning/organising
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💡 Conditions
Past medical history
- Ask about: Parkinson’s disease, vascular disease/diabetes, head injuries, recent infections
- Psychiatric history
Drug history
- Blood pressure/diabetes medication
- Parkinson’s drugs
- Alzheimer’s drugs: galantamine, donepezil, rivastigmine
- New medications
- Allergies
Family history
- Related conditions, e.g. dementia, vascular disease, depression
Social history
- Living situation, carer/home support
- Mobility/walking aids
- Effect on function/coping with activities of daily living: washing, dressing, cooking, cleaning
- Working/driving
- Smoking, alcohol and other cardiovascular risk factors
- RISK
- To self: wandering, leaving gas on, abuse, neglect by self or others
- To others: aggression, risky behaviour
- Carer’s needs: empathise with the demands; ask about stress, coping, and support
A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management
Ending
- ICE (Ideas, Concerns, Expectations): how does the relative/carer expect you to help? What are they worried about?
- Summarise situation and patient needs. Thank relative.
Why don’t you test your knowledge?
What are the defining clinical features of delirium?
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What are the possible causes of delirium?
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How would you assess a patient’s capacity?
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The characteristic features of delirium are:
-Impairment of consciousness (there is no consciousness impairment in demetia).