Delirium Flashcards
What is the definition of delirium
A disturbance in attention
Change in cognition
Acute development and fluctuates
What are the signs of a change in cognition
Memory deficit
Disorientation
Language disturbance
Perceptual disturbance
What are the consequences of delirium
Increased mortality Prolonged hospital stay More likely to develop consequences Higher incidence of dementia Long term disability
What are the two types of delirium
Hypoactive
Hyperactive
Can be mixed
Describe hypoactive delirium
More common
Patients are withdrawn, drowsy, in bed
Higher mortality risk
Describe hyperactive delirium
Patients will be agitated, physically aware, have heightened responses
May become aggressive
Wander around
What is the pathophysiology of delirium
Derangement of multiple neurotransmitters
Direct toxic insult to the brain
Altered stress responses
What are the predisposing factors for delirium
Advanced age Pre-existing dementia Co-morbidities Post-op Terminal illness Sensory impairment Polypharmacy Depression Alcohol dependency Malnutrition
What are the precipitating factors for delirium
Medications Hypoxia Biochemical abnormality - high salt/sugar Dehydration Alcohol excess Infection - HAP, UTI Environment - loud Catheter CVD - post-MI Constipation Fractured NoF Urinary retention
Which scores can be used to identify delirium
CAM
4AT
Describe the 4AT Test
4 sections
Score out of 12 with 4 or more being suggestive of delirium
Scores alertness, attention (months backwards), AMT4 (age, month etc)
and lastly if its acute/fluctuating
Describe the CAM
Confusion Assessment Method
Must have: acute onset and fluctuation and inattention
Then either:
Disorganised thinking or altered consciousness
How do we manage delirium
Identify and reverse all underlying causes
Environmental factors improved - quiet, calm room with familiar people
Engage and reassure family
Symptom control
Document capacity
FOLLOW UP
What is the last resort for those with delirium
Sedation
with Haloperidol or benzodiazepines
How do you prescribe haloperidol
Anti-psychotic with few anticholinergic SE
Start low (max 5mg in a day)
Give orally
Don’t give to those with Parkinson’s
