Delirium Flashcards
Key features of delirium?
Key features: > Disturbed consciousness - Hypoactive/hyperactive/mixed > Change in cognition: - Memory/ perceptual/ language/ illusions/ hallucinations > Acute onset and fluctuant
Other common features:
> Disturbance of sleep wake cycle
> Disturbed psychomotor behaviour – DELIRIUM AFFECTS YOUR PHYSICAL FUNCTION
> Emotional disturbance
Hyperactive delirium?
Combative
Agitated
Restless
Hypoactive delirium?
Lethargic
Sedated
Stupor
Why does delirium happen?
No one really knows although speculated to be due to systemic inflammation which leads to over-activation of the hippocampus by PGE2 and IL-1Beta
Delirium - What precipitates it?
> Infection (but not always a UTI!)!! > Dehydration > Biochemical disturbance > Pain > Drugs! > Constipation/Urinary retention > Hypoxia > Alcohol/drug withdrawal > Sleep disturbance > Brain injury - Stroke/tumour/ bleed etc. > Changes in environment/emotional distress > Sometimes no idea and often multiple triggers
How common is delirium?
1) Commonest complication of hospitalisation
2) 20-30% of all in patients
3) Up to 50% of people post surgery
4) Up to 85% of people at end of their life
Why do we care so much about delirium?
1) Massive morbidity and mortality
2) Increased risk of death
3) longer length of stay
4) Increased rates institutionalisation
5) Persistent functional decline
How is delirium diagnosed?
The 4AT
How to manage delirium?
> Treat the cause
- Full history and exam (incl. neuro)
- TIME bundle
> Explain the diagnosis!
> Pharmacological measures
Non-pharmacological measures
How to manage delirium - Non-pharmacological measures?
> Re-orientate and reassure agitated patients > USE FAMILIES/CARERS > Encourage early mobility and self-care > Correction of sensory impairment > Normalise sleep-wake cycle > Ensure continuity of care - Avoid hospitalisation if possible - Avoid frequent ward or room transfers > Avoid urinary catheterisation/venflons > Discharge people (if in hospital) ASAP
How to manage delirium - pharmacological measures?
> Remember DRUGS ARE BAD (mostly….)
> STOP BAD DRUGS
> Drug treatment of delirium usually not necessary
> No evidence it improves outcomes
> Only if danger to themselves or others or distress which cannot be settled in any other way
- Start low and go slow
- 12.5mg quetiapine orally
- THIS SHOULD BE A CONSULTANT/REGISTRAR DECISION
MDT
How often is delirium preventable?
In around 30% of cases
How can delirium be prevented?
1) Regulation of bowel and urinary function
2) Orientation and ensuring patient have sensory aids as required (Glasses/heariing aids)
3) Promoting sleep hygiene
4) Early mobilisation
5) Pain control
6) Prevention, early identification and treatment of postoperative complications
7) Maintaining optimal hydration and nutrition
8) Supplementary oxygen if appropriate
9) Medication review
Things to remember in delirium?
1) Do they have capacity
2) Do they have a legally appointed proxy decision maker
If someone is delirious what is the increased risk of falls?
4.5 times more likely to experience a fall
