A 82 year old man is brought into the Emergency Department confused. He is a nursing home resident and was visited by his daughter, who was concerned he was becoming more confused.

She reports that he has become progressively more confused over the last 3 days. He was visited by the GP who started him on Trimethoprim for a UTI. He was also seen in the department 4 days ago following a fall. He also has a background of dementia. He takes no current other medications and has no allergies and is a non-smoker.

On Examination

  • Obs: HR 84, BP 154/94, RR 18, Temp 37.6, SpO2 100% on air.

  • CVS: Nil remarkable.

  • Resp: Nil remarkable.

  • Abdominal: Nil remarkable.

  • Neuro: No focal neurology, GCS 14/15 due to confusion but pupils equal and reactive to light.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. What further questions would you like to ask and why?

  2. What does your current differential diagnosis include?

  3. How would you investigate this patient?

  4. If this patient was to become aggressive how might you manage that aggression within the department?

  5. Describe the positive CT head findings. What is the most likely diagnosis and what is the reason for the shape of the opacity?

  6. How would you manage this patient?

  7. If this patient was unfit for surgery, what further discussions do you need to have with the family?

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