Delirium

Question 1

What is the CAM - confusion assessment methods?

Answer 1

AID/A methods
A - acute onset of fluctuating course
I - inattention
D - disorganized Thinking OR
A - altered level of consciousness

Question 2

What’s considered cognitive change?

Answer 2

Memory deficits, Disorientation, language disturbance

Question 3

What’s considered perceptual change?

Answer 3

Illusion, Hallucinations

Question 4

Diagnostic criteria for Delirium

Answer 4

1. disturbance of consciousness (decreased attention)
2. cognitive change or perceptual disturbance
3. RAPID onset (hours or days) and FLUCTUATING daily course
4. evidence of a causal physical condition

Question 5

What’s included in the lab part of work-up?

Answer 5

CBC, lytes, LFTs, ammonia, TSH, Cr, B12, Ca, Gluc, UA, ABG

EGG

Question 6

What’s included in the imagine part of workup?

Answer 6

CXR

Brain imaging and EEG not helpful unless evidence of cerebral trauma/stroke/seizure

Question 7

Correct or NOT: Eval of delirum should included checking meds and substance (ETOH)?

Answer 7

Correct

Question 8

What’s the mnemonics for causes of delirium

Answer 8

I WATCH DEATH
I - infection
W - withdrawal
A - acute metabolic
T - trauma
C - CNS
H - hypoxia
D - deficiencies
E - endocrine
A - acute vascular
T - toxin/drugs
H - heavy metals

Question 9

Unable to do serial 7s, serial 3s or spell WORLD backward

Answer 9

Abnormal in Executive Function disorders or difficulty with Attention and Concentration

Question 10

Acute aggression due to delirium - pharm treatment

Answer 10

1. Haloperidol: po or IM (check QT interval)
2. Quetiapine (seroquel): DOC for Lewy body, Parkinson’s, AIDS related dementia, and ESP
3. ETOH withdrawal or Benzo withdrawal: benzos

Question 11

What’s considered disturbed consciousness?

Answer 11

decreased attention or environmental awareness

Question 12

RF of delirium

Answer 12

1. Dementia (MC)
2. Age, co-morbid physical problems (sleep depriv, immobility, dehydration, pain, sensory impairment)
3. hospitalization or surgery
4. Fecal impaction

Question 13

What’s the sx of anticholinergic-induced delirium?

Answer 13

Early - visual impairment, dry mouth, constipation, UI

Late - inc HR, mydriasis, dec bowel sounds

Question 14

What’s the sx of serotonin syndrome?

Answer 14

Early - tremor and diarrhea

Late - Hyperreflexia, clonus, myoclonic jerks, inc bowel sounds, diaphoresis

Question 15

What’s the sx of NMS?

Answer 15

Early - EPS

Late - Marked rigidity, bradyreflexia, hyperthermia

Question 16

Which categories of meds have strong anticholinergic property?

Answer 16

1. Antidepressant - TCA and Paroxetine
2. Antihistamine - diphenhydramine (Benadryl, Dramamine, Nytol), hydroxyzine (Vistaril, Atarax), loratadine (Claritin), cyproheptadine, clemastine
3. Antimuscarinics (Rx for urge UI): oxybutynin
4. AntiParkinson agents: Benztropine, trihexyphenidyl
5. Antipsychotics: chlorpromazine (CPZ, Thorazine), clozapine, lozapine, olanzapine, perphenazine, prochlorperazine, promethazine, thioridazine, trifluoperazine
6. Antispasmodics - atropine products, scopolamine
7. Skeletal muscle relaxant - cyclobenzaprine (Flexeril), Tizanidine (Zanaflex)

Question 17

First line for treating delirum

Answer 17

Safety - use family or sitters

No physical restrain unless necessary