Acute confusion and safe first actions
PLAB pack: SBA + explanation
Theory
Theory 1: Station focus
Acute confusion tests delirium recognition, reversible causes and immediate safety.
- Onset and baseline cognition.
- Infection, hypoxia, glucose, medication and pain.
- Capacity and safeguarding risk.
Theory 2: Reasoning path
Delirium is acute and fluctuating; look for reversible causes before labelling dementia.
- Identify the immediate risk.
- Choose the safest first action.
- Explain why the distractors are weaker.
Theory 3: Expected output
The candidate should assess ABCDE, check glucose, treat causes and protect the patient.
- ABCDE and glucose.
- Medication/infection review.
- Capacity and safe supervision.
Vocabulary and model dialogue
Doctor: Was this confusion sudden, and what is she normally like?
Relative: She was normal yesterday, but today she is very drowsy.
Doctor: We will look for reversible causes such as infection, low oxygen or low glucose.
Practice
Practice 1: Stem analysis
An older patient becomes acutely confused overnight after a urinary infection and poor oral intake.
Output: Age, timing, symptoms, vital risk and one missing question.Practice 2: First action
Choose the first safe action: ABCDE assessment, capillary glucose, observations and infection review.
Output: One action plus clinical reason.Practice 3: Differential
Compare Delirium due to acute illness with two alternatives.
Output: Three-line differential table.Practice 4: Exam response
Write the first five checks and a family explanation.
Output: Checklist + explanation.Interactive tasks
Interactive 1: Red-flag sort
Sort findings from "Acute confusion and safe first actions" into urgent and non-urgent details.
Interactive 2: Distractor removal
Remove the least plausible option from: New dementia diagnosis without assessment, Primary migraine, Routine discharge.
Interactive 3: Timed response
Give a 90-second exam answer using the station output steps.
Quiz
Acute fluctuating confusion in illness is delirium until proven otherwise.
The safest answer addresses the immediate clinical risk first.
Exam documentation must record the detail that changes management.
Safe exams include patient understanding and escalation advice.
The station expects a short, defensible clinical chain.