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CONFUSED Patient• The confused patient may be disorientated for place and time, unsure of his/her own name, and may have a poor attention span and altered sleep pattern.• If the confused patient is also aggressive, try to assess and manage confusion before sedating the patient 50.Recognise the confused patient needing urgent attention:• Sudden onset of confusion or disturbed speech or behaviour, perhaps with weakness, visual disturbance that may have resolved: stroke likely 76• Had a fit 2• Sudden onset over hours or days of confusion with impaired awareness, varying levels of alertness and drowsiness and change in sleep pattern: delirium likely• Temperature ≥ 38ºC• Head injury within past 6 weeks• Finger prick blood glucose ≤ 3.5Management:• Give face mask oxygen.• If glucose ≤ 3.5, give oral glucose or 40–50ml dextrose 50% IV. If confusion resolves, refer only if on glibenclamide, gliclazide or insulin. If diabetic 71.• If temperature ≥ 38ºC: give ceftriaxone 1 2g IM/IV immediately.• Alcohol withdrawal (known alcohol user who has taken less alcohol for 12 hours): give thiamine 100mg IM and diazepam 10mg orally and oral rehydration.• Drunk (smells of alcohol, recent drinking): give 1l sodium chloride 0.9% with thiamine 100mg IV over 4 hours. Refer only if still confused when drip complete 83.• Refer same day to hospital unless confusion resolves when sober or with glucose not on glibenclamide, gliclazide or insulin.Approach to the confused patient not needing urgent attentionIs the patient psychotic?Lack of insight with 1 or more of hallucinations (hearing voices), delusions (fixed false beliefs) and disorganized speech and behaviour.YesNoPsychosis or mania 84Has patient had memory problems and been disoriented for at least 6 months?YesNoDementia likely 86Refer same day for assessment.1Do not mix Ringer's lactate and IV ceftriaxone. Flush IV line with sodium chloride 0.9% before and after IV ceftriaxone. If giving ceftriaxone IM, divide dose: 1g into 2 different injection sites.51