Delerium

Question 1

what is delirium

Answer 1

1. ACUTE CONFUSION
   - important to know baseline
   - colateral history is important for this
2. ALTERED CONCIOUSNESS
   - low GCS or AVPU
   - reduced awareness of environment
3. IMPAIRED COGNITION
   - reduced attention
   - AMTS or MoCA
   - memory also affected (short term and recent)
   - not orientated in time person place

ADDITIONAL

• visual hallucinations
• mood disturbance (agitated or aggressive)
• psychomotor abnormalities
• sleep wake cycle disturbances

Question 2

What are the types of delirium?

Answer 2

• Delirium tends to present in either an hypoactive or a hyperactive state.
• There is also a mixed type which presents features of both

Question 3

What are some inter cranial causes of delirium?

Answer 3

INTRACRANIAL CAUSES:

• Lewy Body dementia
• other types of dementia
• space occupying lesion
• head injury
• Meningitis
• Encephalitis
• epilepsy

Question 4

cerebrovascular causes of delirium?

Answer 4

-TIA/stroke
-cerebral thromboembolism
-intra-cerebral or sub arachnoid haemorrhage
-hypertensive encephalopathy
Vasculitis (SLE)

Question 5

What poisons can cause delerium

Answer 5

• Heavy metals

- Carbon monoxide

Question 6

What is a nutritional cause of delerium?

Answer 6

Thiamine depletion (wernicke’s)

Question 7

What investigations would you do if you were thinking delerium?

Answer 7

Check all vital signs
-HR/RR/O2 sats/BP/temp/CRT/glucose/blood gas
-urine dip to check for infection
BLOODS (FBC/Us and Es/glucose/CRP/ESR/LFT/TFT/Heamotinics (Iron. vitamin B12and folate)
-could do CXR to rule out chest invention
-ECG
-drug levels

Question 8

management of delerium?

Answer 8

1. treat underlying organic cause
2. optimise comorbidities
3. if agitated/very distressed, give sedatives (after trying verbal and non-verbal de-escalation techniques)