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How can I tell if someone is confused?


Updated October 08, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Question: How can I tell if someone is confused?
Confusion is often listed as a major sign of injury or illness. When I was teaching emergency medical technicians, I would sometimes ask students to play a confused patient for our scenarios. Sometimes they got it right but sometimes they just acted psychotic, which is not the same thing. Do you know how to tell if someone is confused, especially if you don't know the person?
Answer: Paramedics usually use a very basic 3- or 4-question test to see if you are confused or not. We're looking for the brain to be able to recognize person, place, time and event. I like to use all 4 questions, but some paramedics leave out the event question.
  1. Person: What's your name?
  2. Place: Where are we right now?
  3. Time: What time (or day or month) is it right now?
  4. Event: What happened?

Depending on how a patient answers these questions, we can determine how confused he or she is. In the best case scenario, the patient will be oriented, able to answer all questions appropriately.

If the patient is not oriented -- confused, in other words -- we want to know just how disoriented the patient is. We do that based on which questions the patient can answer correctly.

If the patient is able to tell me where he is and what his name is, we call that oriented to person and place only. Sometimes a healthcare professional might say the patient is oriented x2 (times two), but then you can't be sure which questions the patient can answer and which ones he can't. Knowing the specifics may make a difference in the patient's care.

Confusion or Eccentricity?

The biggest mistake new healthcare providers or lay rescuers make is to mix up eccentricity, delusion, or even psychosis with confusion. What makes confusion special is that even if you're a little odd, you still remember who you are, where you are, approximately what time it is and what you're doing.

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