Delirium

Question 1

What is the acronym for delirium?

Answer 1

D= drugs and alcohol
E=2.718 eyes and emotional disturbances and ears
L=low output state
I= infection
R= retention
I=ictal
U= underhydration or nutrition
M= metabolic disorders
S=subdrual haemaotma and sleep deprivation

Question 2

Which drugs can cause delirium?

Answer 2

Anticholinergic
Opiates
Anticonvulsants
Recreational drugs

Question 3

What low-output states cause delirium?

Answer 3

Myocardial infarction
Acute respiratory distress
PE
Congestive heart failure
COPD

Question 4

Which metabolic disorders can cause delirium?

Answer 4

Wernicke’s encephalopathy
Thyroid disorders
Electrolyte imbalance

Question 5

How does delirium present?

Answer 5

Disorientation
Hallucinations - visual or auditory
Inattention
Memory problems
Change in mood or personality. Sundowning is agitation and confusion worsening in the late afternoon or evening.
Disturbed sleep

Question 6

What is used to assess delirium?

Answer 6

4AT for
Bedside evaluation of alertness
Abbreviated mental test
Months of years backwards
Evaluation of recent acute changes in mental status

Bladder scan
Urine microscopy
FBC, LFTs, U&Es
Neuroimaging is reserved for unclear identifiable cause

Question 7

What is the management of derailment?

Answer 7

Providing an environment with good lighting
Maintaining a regular sleep-wake cycle
Regular orientation and reassurance
Ensuring the patient’s glasses and hearing aids are used if needed