The organization of this clinical mind map is based upon mechanisms of disease arising from various sources. The mnemonic I WATCH DEATH is easy to remember and follow. First, delirium must be identified as a patient presentation. Delirium is an altered mental state of significant confusion and often noted or reported by the patient care team, family members or friends. Probable diagnoses can be memorized based upon this mnemonic and can be re-organized based upon patient specific situations. For example, in a young healthy patient, delirium should evoke pathologies such as acute toxic exposure, infections and drugs more than pathologies which are more prevalent in older age groups. Knowledge of pre-existing diagnoses can also help narrow the differentials.
Urgent/emergent situations can arise from almost any pathology and are reflected in abnormal vital signs, lack of orientation to place, person, or time and the patient’s appearance.
Weighing and removing anchor bias involves gathering data from the patient history, physical exam, and labs and/or tests. The past medical history, including identification of risk factors which can lead to various delirious states, can be extremely helpful. Due to the overlap of clinical features among various pathologies, the patient may have more than one pathology at play. Therefore, it becomes very important for a clinician to remove anchor bias, avoid premature closure, and not miss a second diagnosis, even if one correct diagnosis has already been made.