Delirium Flashcards
factors favouring delierium over dementia 6
acute onset
impairment of consciousness
flucation of symptoms: worse at night, periods of normality
abnormal perception oe illusions and hallucinations
agitation, fear
delusions
how can causes for delirium be classified 8
infection
metabolic
medications
endocrine
neuro
nutrition
illicit
metals
regarding causes of delirium give examples for the following:
Infection 1
sepsis
eg UTI, URTI, CNS, BBV(blood borne virus)
regarding causes of delirium give examples for the following:
Infection 1
sepsis
eg UTI, URTI, CNS, BBV(blood borne virus)
regarding causes of delirium give examples for the following:
metabolic 5
ANS instability
hypoglycaemia
dehydration
electrolyte distrubance
organ failure
regarding causes of delirium give examples for the following:
metabolic 5
ANS instability
hypoglycaemia
dehydration
electrolyte distrubance
organ failure
regarding causes of delirium give examples for the following:
medication 5
steroids
anticholinergics
psychotropic (benzos)
dopamine agnoists
opioids
regarding causes of delirium give examples for the following:
endocrine 4
thyroid
PTH
adrenal
pituitraty
regarding causes of delirium give examples for the following:
neuro 6
trauma
bleed
epilepsy
vasculitis
ICP (increased intracrainial pressure)
SOL (space occupying lesion)
regarding causes of delirium give examples for the following:
nutrition 4
malnutrition
deficiencies:
-thiamine
-folate
-B12
regarding causes of delirium give examples for the following:
illicit 3
alcohol
benzos
amphetatmins
regarding causes of delirium give examples for the following:
metals 3
CO
lead
mercury
who is at risk of delirium 10
old
young
underlying brain injury
blind/deaf
post-op
previous sustabnce misuse/psych issue
sleep depriviation
pain
stress
clinical features of delirium 6
rapid fluctuation confusion (mins-hours)
clouding consciousness (clarity of awareness environment)
psychosis; delusions, hallucinations, illusions
emotional lability
sleep/wake distrubance, reversal
describe the difference between hyperactive and hypoactive delirium 3v2
hyperactive- increased motor actiivyt , agitiaton, psychosis
hypoactive- reduced motor activity, drowsy (poor prognosis)
assessment in delirium 6
clinical history
cognitive assessment
physical exam
blds
toxicology screen
infection screen
head imaging/LP
EEG
assessment in delirium 6
clinical history
cognitive assessment
physical exam
blds
toxicology screen
infection screen
head imaging/LP
EEG
describe the confusion assessment method (CAM) used in delirium 4
CAM:
1- Acute onset
2- Inattention
3- Disorganised thinking
4- consciousness (alter->hyperalert->drowsy->stupor->coma)
need 1+2 (+3 or 4)
what are the domains of management for delirium 3
physical
environment
medical
physical mangement of delirium 4
treat underlying cause
-stop/avoid offending drug
-O2
-hydration/nutirtion
-continence
-analgesia
-sleep e
physical mangement of delirium 4
treat underlying cause
-stop/avoid offending drug
-O2
-hydration/nutirtion
-continence
-analgesia
-sleep e
environmental managemnt of delirium 6
move to single room
avoid ward/hospital move
avoid restrianing
make environment safe
familitratiy:
-same staff
-allow TV
-visitors
-orientation- glassess/hearing aids
-windows
-low lighting at night
-clock
-clarity when speaking
what are the domains of management for delirium 3
physical
environment
medication
what are the domains of management for delirium 3
physical
environment
medication
medication mangement of delririum
last resort
-lowest dose possible
Rapid transquilization protocols
-benzos
-antipsychotics (atypical > typical)
medication mangement of delririum
last resort
-lowest dose possible
Rapid transquilization protocols
-benzos
-antipsychotics (atypical > typical)
when should antipsychotics not be used in management of delirium 2
if concenrs about lewy body dementia or parkinsons
what should be monitored if medication used for delirium management 2
RR
BP
1hr post adminions
what should be monitored if medication used for delirium management 2
RR
BP
1hr post adminions
risks with benzo use for delirium 3
oversedation
airway compromise
falls
risks with antipyschotic use in delirirum mangement 5
cardio-respiroatyr collapse
interactions with illicity medications
prolonged QTc (esp Haloperidol- ideally ECG before)
increased stroke risk in elderly
damage to therapeutic relationship
examples of drugs that can cause prolonged QTc 5
amiodarone
levofloxacin/cirpofloxacin
amitriptyline
haloperidol/quetiatpins
sumatriptan
state the three types of observation level 3
general
constant-eyeline
special- arms reach
what legalities are used in care of delirium and when
AWI-section 47
-medical interventions
-ward care
MHA (EDC)
-if trying to leave ward
-requiring restraint
