Delirium Flashcards
what causes of delirium may cause direct toxicity on the brain
low Na
hypoglycaemia
hypoxia
drugs
risk factors delirium
elderly preexistent cognitive impairment postop sensory impairment previous hx delirium drug or alcohol dependence depression polypharmacy comorbidity ICU admission
causes of delirium
drugs electrolyte disturbance lack of drugs reduced sensory input/pain intracranial urine retention/constipation metabolic
metabolic causes of delirium
AKI hypoglycaemia hyponatraemic hypothyroid B12 Ca
features of hyperactive delirium
agitation aggression wantering sudden, hours, days fluctuating hypervigilatn impaired attention disordered thinking distorted perception with delusion, illusion and hallucination
features of hypoactive delirium
withdrawn apathetic sleepy hallucination/delusion slow sudden, hours, days fluctuating
features of mixed delirium
mix of hyper/hypoactive delirium
admission screening for delirium
all >65
important as a baseline even if they dont have it
4AT
components of the 4AT score
alertness
4AMT - age, DOB, place, year
acute onset?
attention - months backwards
TIME bundle - componenets
trigger
investigate/intervene
manage
explain and engage
features of trigger - TIME
sepsis blood glucose meds pain urine retention constipation other causes
features of investigation/intervention - TIME
hydration and fluid balance chart bloods ECG sepsis 6 and look for symptoms hx and full exam triage with high NEWS blood glucose med review CT head
features of manage - TIME
treat cause
features of engage/explain - TIME
explain to patient, family, carers
document diagnosis
non pharmacological management of delirium/agitation
optimise chronic disease tx chart activity mobilise as safe to do so sensory input food, fluid, bowel chart reorient patient and reassure minimal ward moves
pharmacological management of agitation and delirium
only for failing non pharm mx assess capacity if symptoms threaten safety to pt, staff, others or psychotic symptoms 1st line haloperidol, oral or IM Lorazepam DLB/parkinsons
when should haloperidol never be given
Dementia with lewy bodies
Parkinsons disease
can precipitate further EPSE
give lorazepam instead
non pharm intervention to prevent delirium?
regular orientation minimal moves oral hygiene glasses/hearing aids if needed pain control nutrition/hydration
ways to prevent post operative delirium
minimise anaesthetic time and depth
pain control
recognise complications
review bowel and bladder function
