Delirium Flashcards
delirium tends to fluctuate during the day, true or false
true
how long does delirium last
can last hours/days to months
risk factors for delirium
- elderly
- pre-existing cognitive impairment e.g. dementia
- post-op
-sensory impairment e.g. deaf/blind - previous history of delirium
- drug/alcohol dependence
- depression
- polypharmacy
- multiple co-morbidities
- critical care admission e.g.HDU/ITU
common causes of delirium
- infection
- dehydration
- constipation
- polypharmacy
- drugs and alcohol
- cardiovascular events
- falls and hip fracture
- electrolyte disturbance e.g. low or high sugar
features of delirium
- acute onset
- fluctuating course
- altered conscious level (may be hypo/hyperactive)
- inattention/decreased awareness
- disorganised thinking (may include psychotic features e.g. hallucinations)
all patients over ___ years old should be screened for delirium on admission to hospital
65
at what 4-AT score would we think delirium?
> 4
what score is used for delirium screening
4AT
when would CT scan be a useful in delirium
falls/head injury
stroke
investigating delirium
- history
- full examination
- neuro exam
- is the patient in pain?
- basic obs/NEWS
- blood sugar
- medication review
medication “culprits” for delirium
Opioids - e.g. tramadol
Anticholinergics – amitriptyline, oxybutynin, solifenacin…
Sedatives – benzos, sleeping tablets, anti-histamines (includes ranitidine!)
Psychotropic medications – lithium, anti-psychotics, anti-depressants (SSRIs)
Anti-epileptics – phenytoin, phenobarbital, carbamezapine
Cardiac medications – digoxin, anti-hypertensives
Steroids, NSAIDs
Anaesthetic agents
Withdrawal of medications/alcohol/nicotine
Parkinson medications – although NEVER stop these acutely without d/w PD specialist
why is fluid chart important in management of delirium
dehydration will exacerbate delirium
what is the pharmacological management of agitation where non-pharmacological methods have failed
haloperidol 500 micrograms orally
when would haloperidol NOT be used for agitation
in parkinsons or lewy body dementia
- use lorazepam instead
