Clinical examples
Illustrated cases
Forty cases exploring delirium, from the first change in someone’s thinking to assessment, treatment and recovery. Open a case to read the comic, commentary and transcript.
The 12 illustrated 4AT cases form a separate collection.
Search titles, clinical topics, dialogue and commentary.
40 cases
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Case 1Not joining the conversation
Hypoactive delirium after admission
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Case 2Clearer this morning
Include the overnight history
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Case 3A change beyond dementia
Delirium can add to dementia
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Case 4More than one cause
Care and reassessment after hip surgery
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Case 5Frightened by the ward
Support when fear returns
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Case 6Check what changed in the medicines
Review the causes and the response
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Case 7The hearing aid is missing
Support communication during assessment
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Case 8No relative available yet
Records can show the change
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Case 9Parkinson's disease and new delirium
Preserve usual treatment and reassess
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Case 10Delirium at discharge
Plan support and follow-up
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Case 11New confusion, harder breathing
Assess acute illness while looking for causes
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Case 12Ask about the bowels
A missed problem during delirium
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Case 13The urine culture is positive
Check what the result actually explains
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Case 14A history that changes treatment
Recognise severe alcohol withdrawal
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Case 15Assess her in her language
Support communication from the start
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Case 16The fear remains
Listening after delirium in intensive care
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Case 17Confusion after a fall
Look for neurological warning signs
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Case 18Getting moving again
Assess function during delirium recovery
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Case 19A week later, still not herself
Review persistent symptoms
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Case 20Comfort and possible causes
Delirium during palliative care
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Case 21The hip is healing
Reassess pain, medicines and retention while continuing rehabilitation during delirium.
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Case 22The infection settles
Distinguish physiological stability, persistent delirium and longer-term cognitive disability in dementia.
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Case 23Problems that develop along the way
Show how poor intake, swallowing difficulty, immobility and device burden complicate delirium.
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Case 24Fluids are only part of the answer
Manage dehydration and kidney injury without overlooking fluid overload, drug accumulation or continuing cognitive needs.
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Case 25Home is another stage of care
Plan for residual symptoms, recognise a new acute illness after discharge and reassess longer-term care needs.
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Case 26A late change for the better
Continue assessment and rehabilitation when a prolonged course has prompted an assumption of permanent decline.
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Case 27She has stopped calling out
Assess subjective distress when agitation reduces but fear and inattention continue.
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Case 28A quieter ward round
Observe benefit and harm after symptom-directed medication; reassess cognition and movement separately.
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Case 29Before the next attempt
Interpret resistance during personal care through acute change, pain, hearing and fear.
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Case 30A new change within delirium
Avoid attributing fresh drowsiness or rigidity to established delirium; check new illness and medication delivery.
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Case 31The blood tests are better
Retain an acute cognitive formulation when mood symptoms and apparently reassuring laboratory results distract from fluctuating inattention.
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Case 32Confusion before the fever
Recognise delirium as an early sign of postoperative illness and separate surgical from cognitive recovery.
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Case 33After the tremor settles
Treat withdrawal and nutritional risk while reassessing persistent delirium for concurrent illness.
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Case 34The medicine missing from the list
Reconstruct actual medication exposure and identify withdrawal after an unintentional interruption.
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Case 35Comfort and the chance to speak
Combine assessment of reversible contributors with goals of care, symptom relief and an uncertain end-of-life course.
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Case 36The ward is quieter now
Separate active delirium, weakness and distressing memories across ICU transfer and recovery.
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Case 37Two explanations can both be true
Investigate neurological concern despite a plausible systemic cause, and follow residual delirium after treatment.
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Case 38The same pause, again
Recognise stereotyped episodes within an apparently fluctuating delirium course and obtain appropriate EEG assessment.
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Case 39The history began before admission
Recognise a subacute encephalitic syndrome when correction of a common abnormality leaves unexplained memory change and focal seizures.
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Case 40More than being withdrawn
Identify specific catatonic signs coexisting with delirium and assess separate responses to treatment.
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