First aid: the causes and treatment of confusion

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Confusion is more common in older people and is associated with dementia and delirium

It may come on quickly or slowly and may last for a short time before disappearing or may continue for a longer period.

Some people may act strange or aggressive when confused.3

Sudden onset of confusion is often a sign of a medical emergency

It can mean that something is wrong with the brain and could be life threatening. In case of sudden confusion, dial 911.

How to tell if someone is confused

Paramedics typically use a very basic test to determine if a person is confused.5

They are looking for a brain capable of recognizing a person, a place and a time.

An additional event question is also often added.

Person: What’s your name?

Location: where are we?

Time: What time (or day or month) is it right now?

Event: what happened?

Depending on how a patient answers these questions, you can determine how confused they are.

Ideally, the patient will be oriented and able to answer all questions appropriately.

If the patient is not oriented – confused, in other words – paramedics want to know how disoriented the patient is.

They do this based on questions that the patient can answer correctly.6

If the patient is able to tell you where he is and what his name is, this is only about person and place.

Sometimes a healthcare professional may say that the patient is oriented x2 (times two), but then you cannot be sure which questions the patient can answer and which they cannot.7

Knowing the specifics can make a difference in patient care.

Confusion, medical causes

There are several medical causes of confusion. A mnemonic that is used to help remember common causes of confusion is AEIOU-TIPS:8

A: Alcohol

E: Epilepsy

I: Insulin (diabetic emergency)

O: Overdose or lack of oxygen9

U: Uremia (toxins due to kidney failure)10

T: Trauma (shock or head injury)

me: infection

P: Psychosis or poisoning

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S: Stroke

confusion, what to do

If someone around you experiences sudden confusion, it’s important to stay calm, assess the situation, and call for help if needed.

For safety reasons, a confused person should not be left alone.11

Having someone nearby can help keep them calm and protect them from injury.

Try to keep the environment quiet, calm and peaceful. Be reassuring and use simple words and short sentences.

In people with diabetes, sudden confusion may be due to low blood sugar, which requires the consumption of fast-acting sugar, such as juice, soda or candy.12

Have them eat or drink something sweet. If the confusion persists for more than 10 minutes or the person loses consciousness, call the emergency number.13

When to call the emergency number

If a person suddenly becomes confused and has any of the following symptoms, call the emergency number:

  • Cold or clammy skin
  • Dizziness or feeling faint
  • rapid pulse
  • Fever
  • Headache
  • Slow or fast breathing
  • Uncontrolled chills

Also, if the confusion occurs as a result of a head injury or if the person loses consciousness or faints, seek immediate medical attention.

Treatment of confusion

Treatment for confusion depends on its cause, so the doctor may perform several tests, such as:14

  • Mental state tests
  • Blood tests
  • CT scan of the head
  • Electroencephalogram (EEG)15
  • Neuropsychological tests
  • Urine tests

Once the cause is determined, treatment can begin.

For example, if the confusion is caused by an infection, treating the infection should resolve it16.

References:

  1. Gallagher J, Chance RP, Vecchio MD. Case 1: Altered mental status – a state of confusion. Pediatrician Child health. 2010;15(5):263–265. doi:10.1093/pch/15.5.263
  2. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in the elderly [published correction appears in Lancet Neurol. 2015 Aug;14(8):788]. Neurol Lancet. 2015;14(8):823–832. doi:10.1016/S1474-4422(15)00101-5
  3. National Institutes of Health (USA); Study of the biological sciences program. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (USA). Information about mental illness and the brain.
  4. Gower LE, Gatewood MO, Kang CS. Emergency management of delirium in the elderly. West J Emergency Med. 2012;13(2):194–201. doi:10.5811/westjem.2011.10.6654
  5. Inouye SK, Vandyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the method of assessing confusion. A new method for detecting delirium. Ann Intern Med. 1990;113(12):941-8. doi:10.7326/0003-4819-113-12-941
  6. Grover S, Kate N. Delirium Rating Scales: A Review. World J Psychiatry. 2012;2(4):58–70. doi:10.5498/wjp.v2.i4.58
  7. Hegde S, Ellajosyula R. Capacity issues and decision-making in dementia. Ann Indian Acad Neurol. 2016;19(Suppl 1):S34–S39. doi:10.4103/0972-2327.192890
  8. Sanello A, Gausche-Hill M, Mulkerin W, et al. Altered mental status: current evidence-based recommendations for prehospital care. West J Emergency Med. 2018;19(3):527–541. doi:10.5811/westjem.2018.1.36559
  9. Cooper JS, Shah N. Oxygen toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  10. Meyer TW, Hostetter TH. Approaches to uremia. J Am Soc Nephrol. 2014;25(10):2151–2158. doi:10.1681/ASN.2013121264
  11. Portacolone E, Johnson JK, Covinsky KE, Halpern J, Rubinstein RL. The effects and meaning of being diagnosed with mild cognitive impairment or Alzheimer’s disease when living alone. J Alzheimer Dis. 2018;61(4):1517–1529. doi:10.3233/JAD-170723
  12. Gray A, Threlkeld RJ. Nutrition recommendations for people with diabetes. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext [Internet]. South Dartmouth (Massachusetts): MDText.com, Inc.
  13. Mukherjee E, Carroll R, Matfin G. Endocrine and metabolic emergencies: hypoglycemia. Ther Adv Endocrinol Metab. 2011;2(2):81–93. doi:10.1177/2042018811401644
  14. Lorenzl S, Füsgen I, Noachtar S. Acute confusional states in the elderly – diagnosis and treatment. Dtsch Arztebl Int. 2012;109(21):391–400. doi:10.3238/arztebl.2012.0391
  15. Gueguen B, Raynaud P, Guedj MJ. [Indications for EEG in mental confusion and behavior problems]. Neurophysiol Clin. 1998;28(2):134-43. doi:10.1016/s0987-7053(98)80024-5
  16. Fong TG, Tulebaev SR, Inouye SK. Delirium in the elderly: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210–220. doi:10.1038/nrneurol.2009.24

Further reading

  • Confusion: MedlinePlus Medical Encyclopedia. MedlinePlus.

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