Delirium

Question 1

Define

Answer 1

Change or fluctuation in behaviour

• Cognition (poor attention, confusion)
• Perception (hallucinations, paranoia)
• Activity (hyper or hypoactivity)

Causes:

• Constipation
• Urinary retention
• Dehydration
• Electrolyte imbalance
• Infection - sepsis
• Pain
• Medication SEs

Question 2

Airway

Answer 2

Question 3

Breathing

Answer 3

Look: signs of respiratory distress, accessory muscle use
Listen: crackly chest, signs of consolidation/ bronchial breathing
Feel: dullness on percussion, reduced expansion, tracheal deviation

O2: maybe low if sepsis
RR: maybe high if pneumonia/ pain

XCR: exclude pneumonia
ABG: electrolyte imbalances, glucose, lactate!

Question 4

Circulation

Answer 4

Look: mottled (sepsis), diaphoresis
Listen: S1, S2 + 0
Feel:pulses, CRT

BP, HR

ECG - arrhythmia

IV access
Bloods: FBC, UEs, LFTs, CRP, lipids, trops, BNP, blood culture, TSH, B12, folate

Insert catheter and monitor output

Question 5

D and E

Answer 5

PEARL
GCS
neurology
BM

Exposure:
* calves
* abdo exam
* urine culture MC&S
* rashes
* catheter
* urine toxicology screen

Question 6

Management

Answer 6

Non-pharmacological:
* De-escalation techniques (communication + environnent)
* Ensure appropriate lighting (night light)
* Provide continuity of care where possible
* Ensure hearing aids/ spectacles worn
* Maintain good fluid intake
* Treat constipation
* Involve relatives and carers

Pharmacological:
* Sedation is the last resort
* Use oral where possible: Otherwise IM:
* Haloperidol 0.5-1mg PO/IM
* Risperidone 0.5mg PO
* Olanzapine 2.5mgPO
Don’t use anti-psychotics in LBD
2nd line: benzodiazepines e.g. lorazepam 0.5mg PO/IM
If pharmacological management:
HR, RR, temperature, BP, ECG

Question 7

Escalation

Answer 7

If requiring repeated doses over 48 hours consider referral to liaison psychiatry or SAFE (Specialist Advice for Frail Elderly)