Delirium Flashcards
1
Q
Definition
A
Acute fluctuating change in LOC with inattention, disorganised thinking, cognition, perception
- Disturbance in attention->inability to sustain or change
- Change in cognition, or perceptual disturbance
- Occurred over a short period of time, change from baseline, fluctuating
- Direct physiological consequence of a GMC/substance and not occurring when only in coma
2
Q
Pathophysiology
A
Unknown mechanism
- Neurotransmitter->anticholinergic, +dopamine
- Inflammation
- Chronic stress->++cortisol
3
Q
Etiology
A
- Cardiovascular: MI, hypoxia
- Neurological: meningitis/encephalitis, tumor, post-ictal, stroke, Wernickes
- Kidney: failure, urinary obstruction
- Liver: hepatic encephalopathy
- Endocrinology: hypo/hyperglycemia, hypercarbia, alcoholic ketoacidosis, hyponatremia, hypercalcemia, thyrotoxicosis
- Dehydration
- Constipation
- Drug intoxication/withdrawal
- Sepsis
4
Q
History
A
- Medication review
- Previous cognitive status
- Co-morbidities
- Pain
- Alcohol and drug
- Environmental
5
Q
Physical examination
A
- Vitals
- Hydration
- Pupils->drugs, W/D, CVA, +ICP
- Lung examination: infection, CHD, COPD
- CV->CAD, MI
- Abdominal: intra-abdominal infection, constipation
- Suprapubic tenderness->UTI, obstruction
- Hip tenderness
- Neurological
- Mental status examination
6
Q
Initial investigations
A
FBC UEC LFTs ABG Glucose Urinalysis CXR ECG Drug levels
7
Q
Further investigations
A
CT/MRI
LP
EEG->generalised slowing
8
Q
Management
A
- Identify and treat underlying cause
- Medication review
- Non-pharmacological
- Pharmacological
9
Q
Non-pharmacology approach
A
- Continuous observation
- Monitoring vital signs
- Keep oriented, quiet, calm environment
- Hydration, analgesia, nutrition
- Approach from the front
10
Q
Medication if required
A
- Thiamine (before glucose) if suspect alcohol component
- Haloperidol OR olanzepine OR risperidone
- If EPSE->bentripine
