Delirium Flashcards
Define delirium
Acute confusional state with impairments in memory and cognition
Trigger drugs of delirium x5
Steroids
Opioids
Benzodiazepines
Antipsychotics
Sedatives
Where THE F AM I clinical features
Where- disoriented
Thought disorganization
Hallucinations
Energy changes
Fluctuating confusion
Acute
Medical
Intoxication
PINCH ME precipitating factors
Pain unmanaged
Infections UTI
Nutrition
Consitpation
Hydration
Medications
Endocrine - DM, thyroid D
Structural causes of delirium x4
Stroke
Seizures
Hemorrhage
Neoplasms
Risk factors x5
Hospitalization
Male gender
Old age
Alcohol use disorder
Poor vision or cognition
Describe neuroinflammation in pathophysiology of delirium x4
Peripheral inflammation > damaged BBB > increased endothelial permeability > neuroinflammation
Describe old age in pathophysiology of delirium
Diminished physiologic reserves > increased vulnerability to stress and illness
Describe behavior x2 and mood x1 in hyperactive delirium
Uncooperative and combative
Irritable mood
Some investigations for delirium x5
FBC
ABG
Urinalysis
Blood culture
Lumbar puncture
Describe the DSM criteria A to E
A- Inattention
B- acute onset
C- Additional cognitive impairment
D- A & C not explained by pre existing neurocognitive disorder
E- There is evidence of direct physiological consequences of medical condition or substances
Describe the CAM (confusion assessment method)
1 and 2 present and either 3/4
1. Acute and fluctuating
2. Inattention
3. Disorganized thinking
4. Altered level of consciousness
Describe what the 4ATs tests
Alertness- name and address
Attention - months backwards
Acute or fluctuating course
Abbreviated mental test- age, DOB,place and year
Differential diagnosis for delirium x5
Dementia
Depression
Psychosis
Catatonia
Delirium tremens
Psychosocial management x4
Avoid frequent change of staff
Create calm and quiet environment
Family member visitations/pictures
Help in orientation
3 things that increases risk of delirium tremens
Severe dependence
Comorbid infection
Preexisting liver damage
Clinical feature of delirium tremens x6
Agitation
Anxiety
Sweating
Seizures
Tachycardia
Tremors
Dementia complications x5
Pressure ulcers
Aspiration pneumonia
Injuries and fractures
Malnutrition and electrolyte imbalances
Long term cognitive impairment
Pathophysiology of delirium in terms of O2 and N2
Reactive oxygen species and nitrogen > cellular damage because they have low antioxidant capacity
3 reasons why delirium is important
It is common
It is associated with longer hospital stay comorbid
It is associated with increased mortality and morbidity
