Episode Transcript
Interviewer: You or somebody you know suddenly seems very confused. Confusion as a symptom, what could that possibly mean?
Announcer: This is From the Front Lines with emergency room physician Dr. Troy Madsen on The Scope.
Interviewer: Dr. Troy Madsen is an emergency physician at University of Utah Healthcare. Dr. Madsen, as far as symptoms go, if somebody seems confused all of a sudden, whether it is myself or somebody I'm with, what could be the underlying cause of that? For example, with elderly people I know a urinary tract infection can cause confusion, which blew me away.
Dr. Madsen: Right. You know, the average person, and we'll try not to get into the elderly people too much here because that's . . . anything, just a urinary tract infection, like you said, can cause issues.
Let's say we've got the average person out there. Let's say it's a 40-year-old male who normally, has no health issues and just suddenly seems confused. This can be very challenging but for me this is where vital signs are vital. I'm looking at the vital signs because that's what is really going to point me in one direction or another.
First of all, I talk to the person. Yeah, let's say they just seem like they're not quite there. They're not answering questions appropriately. Of course I want to know, did they have anything happen? Were they injured? Did they have a head injury? Are they using any drugs or medications? Anything like that, but in looking at the vital signs that's going to push me in one direction or another.
If they have a fever, I'm thinking possibly meningitis. This person might need a spinal tap or a lumbar puncture to look for some kind of infection around their brain that's causing this. It could be another infection maybe like pneumonia, less likely to make someone just suddenly confused who's normally health, but a possibility.
I'll look at their heart rate. If their heart rate's really fast, and this is something I see quite commonly, heart rate up above 150, up to 200, they might be having an abnormal heart rhythm, something we have to treat either with medication or with a shock to the heart to get that back in a normal rhythm because that really rapid heart rate can make them confused. They're not getting as much blood to their brain.
Maybe their blood pressure is low, and if the blood pressure is low I'm thinking about maybe they're bleeding somewhere. I've see people who have had some kind of internal bleeding either in their stomach or in their intestines that causes their blood pressure to drop down suddenly. They seem confused and weak. That's a very serious thing but I have absolutely seen that happen in young people. Very serious cases of bleeding in someone who maybe is taking a lot of ibuprofen for some pain and it causes some stomach irritation and bleeding.
So those are the primary things I'm looking at, and then I might look at their oxygen level as well. I have seen cases of people with low oxygen levels who have had suddenly a blood clot in the lungs and it goes to the lungs, it causes their oxygen level to drop, their heart rate's up. That causes confusion as well.
For me, again, it's one of these things where it could be any of a number of things, but if you're with someone who is normally healthy, really doesn't have a lot of health issues and suddenly they're confused, that's someone absolutely I would get to the ER and then as an ER doctor there I'm going to be going one direction or another based on what's happened to them prior to that and also really looking at those vital signs to see, okay, is there one direction I need to go here either with infection or with the heart or something in the lungs, something that's causing this confusion to happen.
Interviewer: So it sounds like the cause of confusion is just the brain's not getting enough of something.
Dr. Madsen: Exactly.
Interviewer: Whether that be oxygen, blood. What else would it need?
Dr. Madsen: Well, the blood is delivering the oxygen so typically it's something that's decreasing the blood flow there. Maybe there's just not enough oxygen getting in the body. Certainly young people it's less common but you have to think about strokes or bleeding in the brain.
I have occasionally seen cases of people who seem confused but it's because they're just not speaking correctly. Either they're not pronouncing words correctly or they can think of the right words in their brain but they can't get the words out. That's from either some sort of a stroke, from something breaking off and causing decreased blood flow to the brain or actual bleeding in the brain that's affecting that. Again, these are all things that are emergent issues.
Interviewer: Yeah, sudden confusion is not a good thing, I'm gathering.
Dr. Madsen: Not a good thing.
Interviewer: Go to the ER.
Dr. Madsen: It's not, and it could be any of a number of things, and yes, you should go to the ER.
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updated: August 2, 2019
originally published: June 17, 2016