SAQ. A 70-year-old man is admitted in palliative care for advanced bronchial malignancy. He has developed agitation and restless behavior for 3 hours.
- How will you quickly evaluate him for the precipitating cause?
4A test (4AT) (Box: 34.11)
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- Alertness: name and address
- Attention:
-
- Abbreviated mental test: age, current year, DOB, current place
- Acute or fluctuating course
Total 4AT score (maximum possible score 12)
- ≥ 4: possible delirium ± cognitive impairment
- 1–3: possible cognitive impairment
- 0: delirium or severe cognitive impairment unlikely (but delirium still possible if information in 4 incomplete)
- Mention the immediate management for this patient.
- Hospitalization
- Resuscitation and history taking from attendance
- Sending baseline investigation
- IV fluid, Oxygen, Antibiotic
- Treatment of underlying cause