Acute Confusion Decision Tool

DESCRIPTION (under 4000 chars): IMPORTANT: For use by qualified healthcare professionals only. Acute Confusion & Delirium Tool is a fast, tap-through clinical decision support app for on-call clinicians managing acute confusion. Built for ED, acute medicine, neurology, geriatrics, and GPs. Dark navy design. Full references throughout. ASSESS AND CONFIRM DELIRIUM Interactive 4AT live calculator (Bellelli BMJ Open 2014): tap each of the 4 items to select the score -- Alertness (0 or 4), AMT4 age/date of birth/place/year (0, 1, or 2), Attention months backwards (0, 1, or 2), Acute change or fluctuating course (0 or 4). Running total updates with each tap; once all 4 items selected, instant colour-coded result: score 4 or above = likely delirium, 1-3 = possible cognitive impairment, 0 = delirium unlikely, with breakdown displayed. CAM criteria (Inouye 1990). Subtypes: hyperactive (25%), hypoactive (50% -- frequently missed, worse prognosis), mixed (25%). Delirium vs dementia vs depression comparison table. Delirium on dementia: up to 40% of hospitalised dementia patients. FIND THE CAUSE -- PINCH ME Interactive tick-box checklist: Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment. Urgent bloods guide (glucose, FBC, U+E, LFTs, TFTs, calcium, CRP, ammonia, B12, blood cultures, ABG). When to CT head. Anticholinergic burden drug list (Bishara 2017). Asymptomatic bacteriuria does not cause delirium -- Beveridge 2011. ENCEPHALITIS PATHWAY Do not delay aciclovir -- start immediately if suspected (NICE NG119). HSV: aciclovir 10mg/kg IV TDS, LP protocol, MRI FLAIR temporal lobe pattern. Autoimmune encephalitis: anti-NMDAR (Dalmau NEJM 2018) -- ovarian teratoma, immunotherapy. Anti-LGI1 faciobrachial dystonic seizures. Anti-CASPR2, anti-GABA-B, anti-AMPA. Graus Lancet Neurol 2016. WERNICKE ENCEPHALOPATHY Never give glucose before thiamine (NICE CG100). Risk factors: alcohol, vomiting, malnutrition, bariatric surgery. Classic triad present in only 16% (Harper JNNP 1986). Pabrinex 2 pairs IV TDS x3-5 days. Korsakoff syndrome: irreversible consequence of inadequate treatment. NON-PHARMACOLOGICAL MANAGEMENT NICE NG119 first-line -- 9-item interactive checklist: reorientation, familiar faces, sensory aids, sleep hygiene, mobility, hydration, avoid restraints, remove unnecessary lines, consistent care. Proactive prevention for all admissions aged 65+. DRUG TREATMENT DLB WARNING: antipsychotics potentially fatal in Lewy body dementia (McKeith Neurology 2017). Haloperidol 0.5mg starting dose. Quetiapine 12.5mg for PD and DLB. Lorazepam for specific indications only. Melatonin (Al-Aama 2011). Drugs to stop: opioids, benzodiazepines, anticholinergics. SPECIAL SITUATIONS Alcohol withdrawal delirium: CIWA-Ar, chlordiazepoxide, Pabrinex mandatory, 5-15% mortality untreated (SIGN 74). DLB: full avoidance list. ICU: ABCDEF bundle (Devlin 2018), dexmedetomidine (Riker JAMA 2009). End of life: midazolam, levomepromazine dosing. REFERENCES 23 cited sources, 22 inline citation badges. NICE NG119, CG100, NG97; 4AT; CAM; CIWA-Ar; Inouye Lancet 2014; Dalmau NEJM 2018; Graus Lancet Neurol 2016; McKeith Neurology 2017; Harper JNNP 1986; Devlin Crit Care Med 2018; Riker JAMA 2009; RCP 2020; SIGN 74; BAP guidelines. Font A- / A+ adjustment. No login. No patient data stored. DISCLAIMER For qualified healthcare professionals only. Does not replace clinical assessment or guidelines.