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
Drugs that precipitate abrupt withdrawl
Benzos, Barbituarates, muscle relaxants, ETOH
Which drugs should be eliminated from those at risk for delirium?
Anticholinergics
Peripheral Anticholinergic
Atropine
Most antihistamines fall under which drug class?
Anticholinergic
Should Antibiotics be used heavily with elderly?
No. Can cause multiple problems including delirium
The BEST tx for delirium
Prevention
How do you tx delirium?
Identify and tx the underlying cause
The only approved drug for careful management with Agitated Delirium
Haloperidol - off labe use
