Delirium Flashcards
Types of delirium
Hypoactive, hyperactive, mixed
What is delirium
Acute, transient, global organic disorder CNS functioning resulting in impaired consciousness and attention
Risk factors for delirium
> 65
Dementia
Renal impairment
Sensory impairment
Recent surgery
Multiple comorbidities
Physcial frailty
Male sex
Prev episodes
severe illness
Routine investgiations for delirium
Urine dipstick and culture - exclude UTI
Bloods
ECG
CXR
Screening for infection in delirium
Urine dipstick and culture
FBC - WCC
CRP
Blood culture
Why test for U+Es and calcium in delirium
Electrolyte imbalances
What can cause delirium and lead to LOC that you can test for in an A-E?
Hypoglycaemia
hyperglycaemia can aslo cause delirium
What tests for hyperthyroidism in delirium
TFTs
What nutritional deficiencies can cause delirium
B12, folate, iron-ferritin, nicotinic acid
What investgiation fo you do if concerned about head injury, intracranial bleed or CVA?
CT head
What clinical suspicion would mean you do a LP in delirium?
Meningitis, encephalitis
What does an EEG test for?
Epilepsy
Management of delirium - initial
Treat underlying cause
Correct electrolyte disturbances, treat infections, stop offending drugs
Laxatives for faecal impaction
Temporary catheterisation - urinary retention
Analgesia if sus pain
Why is it important to monitor bowel and urine passing in elderly patients?
Both constipation and urinary retention can cause delirium
Appropriate environment for delirious patients
Quiet, well lit side room, consistency in care and staff, rassure nurses, encourage family and friends, optimise sensry acuity eg glasses, well lit, orientation aids
Medication for delirium
Oral low dose haloperidol 0.5-4mg
olanzapine 2.5-10mg
HE ISNT MAD delirium causes
Hypoxia
Endocrine
Infection
Stroke
Nutritional
Theatre
Metabolic
Abdominal
Alcohol - intoxication or withdrawl
Drugs
Features of DELIRIUM
Disordered thinking, slowed irrational incoherent thoughts
Euphoric, fearful, depressed or angry
Language impaired: rambling speech, repetitive and disruptive
Illusions, delusions - transient persecutory or misidentificatino
Reversal of sleep wake pattern
Inattention
Unaware/disorientated - time, place and person
Memory deficits
Screening tools delirium
Abbreviated Mental test score AMTS
Confusionassessmnet method CAM
4AST
Drugs that cause delirium
Benzodiazapines, opioids, anticholinergics, anti-parkinsonian meds, steroids
Abdo causes of delirium
Hypoxia, electrolyte disturbance, hypoglycaemia, hepatic and renal impairment
Infections causing delirium
Pneumonia, UTI, encephalitis, meningitis
Endocrine causes of delirium
Hypo/erglycaemia, hypo/erthyrodisim, cushings syndrome
Causes of hypoxia -> delirium
Resp failure, MI, cardiac failure, PE
CAM diagnosis of delirium
Acute onset and fluctuating course
Inattention
Disorganised thinking
Altered consciousness
AMTS parameter for cognitive impairment
<8 correct out of 10
Questions on AMTS
Age
Time
Recall address at end - 42 west street
What year is it
Where are you right now
Identify two people
DOB
When did WW2 end
Who is current monarch
Count backwards from 20 to 1
4AT
1) Alertness
2) AMT4
3) Attention
4)Acute change or fluctuating
4 or above = possible delirium +/- cognitive impairment
1-3 = possible cognitive impairment
