Sudden confusion and agitation: causes to investigate! Delirium, dementia, depression.

摘要

You are called to triage to assist as Frank, a frail, older-looking gentleman, is banging on the desk with his cane and yelling, "They're taking my things!" No one is sure what the "things" are, but most people are fearful to get too close or to grab him for fear of being hurt or hurting him. Eventually, you manage to calm Frank enough to place him in a wheelchair, where you attempt a conversation. It is not going well. His answers are disjointed and not making a lot of sense.The admitting clerk suddenly says, "Here! The driver who dropped him off gave me this. Maybe it will help?" Inside an envelope are notes from a local agency. They list the patient's name, medications, allergies, and a short history. It seems the patient has lived independently until recently. His wife died and he was moved to an apartment by his family. He has mild forgetfulness and a question of whether he has dementia. He has been depressed and not sleeping well. He was sent to the emergency department to be evaluated and determine if he needs a higher level of care.