acute confusional state [delirium] Flashcards
1
Q
define
A
Globally impaired cognition and impaired consciousness
2
Q
epidemiology
A
20% of elderly patients on medical and surgical wards
3
Q
aetiology
A
- DELIRIUMS
- Drugs: opioids, anticonvulsants, sedatives, L-DOPA, recreational, EtOH/Dx withdrawal, post-general anaesthetic
- Eyes, ears and other sensory deficits
- Low O2 states: MI, stroke, PE, respiratory, cardiac failure
- Infection: pneumonia, UTI, malaria, wounds, IV lines, encephalitis, meningitis
- Retention: stool or urine
- Ictal: epilepsy, non-convulsive status epilepticus
- Under- hydration / -nutrition: dehydration, thiamine, nicotinic acid, B12 deficiency
- Metabolic: DM (↑↓ glucose), Anaemia, sodium, uraemia, liver failure, malnutrition (beri-beri)
Subdural haemorrhage or other intracranial pathology (SOL, ↑ICP)
4
Q
clinical features
A
- Can last weeks to months
- DELIRIUM
- Disordered thinking: slow, rambling, incoherent ideas
- Emotions:Labile mood
- Language impaired
- Illusions/delusions/hallucinations: Tactile or visual
- Reversal of sleep–awake cycle
- Inattention: attention is poor
- Unaware/disorientated: person, place and time
Memory deficits: Often marked (amnesic post-episode)
5
Q
ix
A
- Bloods: FBC, U+E, LFTs, glucose, ABG, blood cultures, malaria flm
- Urine dip
- Septic screen: urine dip,
- CXR, CT/MRI
- ECG, LP
6
Q
rx
A
- ID and Rx underlying cause
- Surround w/ familiar people
- Nurse in moderately lit, quiet room, same staff (minimise confusion)
- Find glasses, hearing aids…
- Avoid sedatives if possible, but if disruptive:
- Haloperidol 0.5-2mg PO/IM OR olanzapine
- Chlorpromazine 50-100mg PO/IM (avoid in elderly)
7
Q
ddx
A
- Anxiety
- Psychosis
