Delirium Flashcards
A syndrome of confusion caused by underlying disorder
Delirium
More useful than the DSMs to identify delirium
Confusion Assessment Method - CAM
> 95% sensitivity and specificity
Development over a short time and fluctuation during the day
Delirium
This assessment requires: 1. Acute change in mental status and fluctuating course 2. Inattention and either of these: 3. Disorganized thinking OR 4. Altered level of consciousness
Confusion Assessment Method - CAM
Which part of CAM requires you to read the letters “SAVEAHAART” and count the “A’s” a pt can identify?
Inattention
*Read 3 secs apart; ideally, want an error >2
Yes/No Questions like the following, test what part on CAM?
- Will a stone float on water?
- Are there fish in the sea?
Disorganized Thinking
Commanding pts to hold up a certain # of fingers test what on CAM?
Disorganized Thinking
Name the 3 main forms of Delirium
Hyperactive/agitated
Hypoactive
Mixed
Name 4 Neuropathophysiology associations of Delirium
- Cholinergic deficiency (increased anticholinergic)
- Serotonin excess or deficiency
- Inflammation
- GABA and Dopamine
What could be confused with delirium?
Drug/ETOH withdrawl, medication, pain, sleep deprivation, post-op, etc
Which operation is associated with post op delirium?
Hip fracture repair >50%
1 or 2 factors post op = what risk of delirium?
10%
3 or more factors post op = what risk of delirium?
50%
What Tx for high risk post op pt with delirium?
transfusion
During H&P be sure to
Focus on timing of cog changes
Do meds review, including OTC drugs and ETOH
