Delirium Flashcards
What are the 4 key features of delirium
Disturbance of consciousness
Changes not better accounted for by pre-existing/evolving dementia
Develops over short p t + fluctuates
Hx underlying med condition/Dx withdrawal/intoxication
What % hospitalized patients have delirium?
30%
How much higher a risk are dementia patients at of developing delirium?
5-10x
Risk factors delirium (5)
Dementia Multiple co-morbidities Physical fraility Older age Sensory impairments
Precipitating factors delirium (8)
Dx initiation Med illness Systemic infection Metabolic derangement Surgery Pain Brain disorders e.g. stroke Systemic organ failure
How is the diagnosis of delirium made?
AMT + CAM
When is CAM most sensitive + specific?
Acute onset + fluctuating course +
Innattention +
Disorganised thinking/altered level consciousness
What are the 3 types of delirium?
Hyperactive
Hypoactive
Mixed
DDx delirium (4)
Dementia
Focal neuro - Wernicke’s, frontal lobe lesion
Non-convulsive status epilepticus
1’ psych - depression/mania/schizo
Attention - Delirium vs Dementia
Delirium - distracted
Dementia - usually normal
Level of consciousness - Delirium vs Dementia
Delirium - Increased/unchanged/decreased
Dementia - usually norm
1st line Ix Delirium
WCC/CRP U+E LFT Glucose TFT CHX Urinalysis ECG
Mx delirium
Tx underlying cause Mx environment ABC observational approach Dx Mx Monitoring
Examples of how to manage a delirium patients environment (8)
Involve family Soft lighting Clocks/calendars Sleep hygiene Correct sensory impairment Keep mobile/active Avoid multiple rooms Minimise provocation
Dx Mx Delirium
Haloperidol IM/PO
Lorazepam IM/PO
Indications for use of sedative Tx delirium
Agitated pt who = immeidate risk/harm
S term control distress
Things to monitor whilst managing delirium pt (7)
Vital signs Bowels Nutrition/hydration P areas Electrolytes Response to ABx Re-explore diagnosis if not improving
Bedside assessment of Delirium
Confusion Assessment Method
What are the 4 areas scored in the confusion assessment moethod?
1) acute onset + fluctuating course
2) inattention
3) disorganised thinking
4) altered level consciousness
What % of pt never recover from a delirium ep
20%
How much more likely are pt who have delirium to die within a year?
> 60%
