Delirium Flashcards
1
Q
Key features of Delirium
A
- 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
2
Q
What are the subtypes of delirium?
A
- Hyperactive delirium
- Hypoactive delirium
- Mixed
3
Q
The cause of delirium is unknown but what can precipitate it?
A
- Infection (but not always a UTI)
- Dehydration
- Biochemical disturbance
- Pain
- Drugs
- Constipation/urinary retention
- Hypoxia
- Alcohol/drug withdrawal
- Sleep disturbance
- Hypoglycaemia
- Brain injury - stroke/tumour/bleed
- Changes in environment/emotional distress
- Sometimes no idea and often multiple triggers!
4
Q
How common is delirium?
A
- Commonest complication of hospitalisation
- 20-30% of all in-patients
- Up to 50% of people post surgery
- Up to 85% of people at end of their life
5
Q
What scoring system is used to diagnose delirium?
A
4AT score
- Alertness
- AMT4 - age, date of birth, place (name of hospital or building) and current year
- Attention
- Acute change or fluctuating course
- In alertness, cognition or other mental function
6
Q
What is the TIME bundle?
A
A criteria to follow if there is a potential delirium diagnosis.
TIME must be implemented within 2 hours
7
Q
Management of delirium - what to do when you find it
A
- Use TIME bundle
- Full history and exam
- First and foremost treat underlying causes
- Manage sepsis
- DO NOT USE RESTRAINT AND AVOID ANTIPSYCHOTIC MEDICATIONS – these may worsen delirium or contribute to the risk of falls and immobility
- Pharmacological measures
- Non-pharmacological measures
8
Q
Non-pharmacological treatment for delirium
A
- 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/cannula
- Discharge people (if in hospital) ASAP
9
Q
Pharmacological management
A
- Stop bad drugs
- Drug treatment of deliriium is usually not necessary
- 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
10
Q
How to prevent delirium?
A
