Delirium Flashcards
Consequences of delirium.
Increased mortality
Increased length of stay
Worse recovery of underlying illness
More complications
increased risk of developing dementia
What is delirium?
An acute confusional state with a sudden onset and fluctuating course.
It develops over 1-2 days and is recognised by a change in consciousness, either hyper, hypo or inattention.
Clinical features of delirium.
Globally impaired cognition, perception and consciousness developing acutely 1-2 days.
Marked memory deficity
Disorientation in room and thoughts
May have tactile or visual hallucinations.
Types of delirium.
Hyperactive
Hypoactive
Mixed
Explain hyperactive delirium.
Restlessness
Mood lability
Agitation
Aggression
Explain hypoactive delirium.
Slow and withdrawn
Drowsy
Risk factors of delirium.
>65 yo
Dementia or previous cognitive impairment
Hip fracture
Acute illness
Psychological agitation like pain
Give causes of delirium.
Drugs
Epilepsy/Electrolyte imbalance
Liver failure/Low O2 (PE/MI)
Infection
Retention (urinary/faecal)
Intracranial
Uraemia
Metabolism (thiamine, nicotinic acid, B12 def.)
also…
Surgery
Systemic infections UTI is a big one
Alcohol withdrawal
Drug withdrawal (opiates, levodopa, sedatives and recreational)
Trauma
Differentials of delirium.
Dementia
Anxiety
Epilepsy
Primary mental illness can mimic delirium
Investigations of delirium.
Look for the cause.
Bloods - FBC, U&Es, LFTs, blood glucose, ABG, septic secreen (urine dipstick, CXR, blood cultures)
ECG
Malaria film
LP
EEG
CT
Diagnostic criteria of delirium.
Disturbance of consciousness;
- Decreased clarity of awareness of environment
- Decreased ability to focus, sustain or shift attention
Change in cognition such as memory deficitt, disorientation, language disturbance, perceptual disturbance.
Disturbance develops over a short period (hours or days)
Fluctuation over the course of a day.
Non-pharmacological management of delirium.
Reorientate the patients - Explain where they are and who you are at each encounter.
Encourage visits from friends and family
Monitor fluid balance and encourage oral intake
Mobilise and encourage physical activity
Practise sleep hygiene
Avoid or remove catheters, IV cannulae etc…
Watch out for infections
Review medications.
Pharmacological management of delirium.
Treat underlying cause obviously.
Sedatives;
Haloperidol 0.5-2mg
Chlorpromazine 50-100mg PO, IM if not PO.
Wait 20 min to judge effect.
Avoid chlorpromazine in the elderly and in alcohol withdrawal.
Avoid antipsychoicts in those with Parkinsons and Lewy body dementia.
Sedatives are not always used.
When are they used?
Only used if the patient is a risk to their own or other patient’s safety.
Screening tools of confusion.
–AMT4 (good for quick assessments e.g. AE)
–AMT 10 (if less than 8 then CAM/4AT) - Used on admission
–CAM – Confusion Assessment Method
–4AT (emerging as favourite tool)
–SQiD - Single Question in Delirium – Is the person more confused or more withdrawn than normal?
4AT score
