Pitfalls

The pitfalls when managing patients with delirium are:

• Failure to consider the diagnosis, particularly the hypoactive subtype
• Failure to routinely assess the mental state of all elderly patients in the ED
• Failure to obtain a corroborating history from relatives, carers or friends. This is particularly important when trying to distinguish between delirium and dementia
• Failure to obtain a full drug history
• Failure to appreciate that injury (particularly head injury) and pain are important causes of acute confusion
• Requesting insufficient or inappropriate investigations. A full set of all blood tests/x-rays/CT scans is not needed in the initial management of many patients
• Failure to appreciate that environmental factors are vitally important in the prevention and treatment of delirium
• Avoid sedating patients unless absolutely indicated