Delirium

Question 1

What is spurious diarrhoea?

Answer 1

Severe constipation with leakage of faecal fluid

Question 2

What are the common predisposing factor for delirium?

Answer 2

• Advanced age
  
  • Previous Hx of delirium
  • Hearing and visual impairment
  • Functional disability
  • Immobility
  • Malnutrition
  • Hydration
  • Drugs
  • Presence of chronic disease

Question 3

Outline the CAM scale?

Answer 3

• CAM Scale - Presence of 1 & 2, and either 3 or 4
  
  1. Acute and Fluctuating course
  2. Inattention
  3. Disorganised thinking
  4. Altered level of consciousness

Question 4

What are some common precipitating for delirium?

Answer 4

• Drugs
  
  • Primary neurological diseases
  • Intercurrent illness
  • Surgery
  • Unfavourable environmental factors - including many hospital interventions such as indwelling catheters
  • Prolonged sleep deprivation

Question 5

DELIRIUM for causes

Answer 5

D - Drugs: opioids, anticonvulsants, 
E - Hypoglycaemia, Na, liver
L - Lack of medications (missing meds)
I - Infection
R - Reduced sensory imput
I - Intracranial lesions
U - Urinary or faecal incontinence
M - Myocardial or pulmonary pathology

Question 6

What might you do in a delirium screen

Answer 6

BSL
Bloods: FBE, UEC (Na, K), CMP, CRP/BSL, ABG (if concerned), B12/Folate, cultures if septic
CXR: Symptomatic only
Urine: Urinalysis, MCS
ECG, troponin

Question 7

The Yale Delirium Prevention Trial showed that control which 6 risk factors reduced the number and duration of delirium?

Answer 7

• Cognitive impairment
• Hydration
• Mobility
• Sensory impairment - Hearing and vision
• Sleep deprivation

Question 8

What is a good neurocognitive test for attention?

Answer 8

Counting back numbers

Question 9

How do you managed delirium?

Answer 9

• Identify and treat the cause
  
  • Calm the patient down as much as possible
  • Modify the environment to optimise it
  • Consider pharmacological intervention
    ○ Are they at danger to self or other
    ○ If starting one try an atypical antipsychotic first - olanzapine, risperidone, or quetiapine
    § 12.5 quetiapine
    § 2.5 risperidone
    ○ Consider haloperidol if atypical doesn’t work (due to SE profile)
    § 2.5mg
  • Consider special
  • Melatonin/Doneprazil/Memantine all trialled but none successful
  • Resolves with time
    Explain the family what’s going on