Initial Assessment

Investigations should be guided by the findings of the history and examination.

They should assist in narrowing the differential diagnoses and distinguishing between organic and psychiatric origins.

Several investigations may be required, but only a few will give results within the time frame of the patient’s stay in the ED what are they?

• Nursing observations
• Blood glucose (BM)
• U&Es
• Thyroid function test (TFT)
• Full blood count (FBC)
• Liver function test (LFT)
• CT Head

Those with an organic cause of altered mental state should be managed appropriately with treatment of the underlying cause.

Delirium, hallucinations and disorientation in these patients can place them at risk of harming themselves and others, as well as causing disruption on the ward.

It is important to optimise the management of these patients by considering environmental factors, e.g. well lit or dimly lit room, nursing on the floor and consideration of pharmacological methods of sedation.