Delirium/Acute confusional state Flashcards
By what mechanism can the following contribute to developing delirium
- dihydrocodeine
- bendroflumethiazide
- ferrous sulfate
by causing
- constipation
- dehydration + low Na
- constipation
name the 2 tools used to assess delirium
4AT
CAM
following an episode of delirium what are patients subsequently more likely to develop?
further episodes of delirium
+
dementia
Name 7 features that delirium presentations may include
- disturbed sleep cycle
- agitation or withdrawn
- visual hallucinations
- mood change
- poor attention
- disorientation
- memory disturbances (short>long term)
name the 4 hallmarks for a diagnosis of delirium
1) acute onset
2) consciousness disturbed
3) impaired cognition not due to pre-existing dementia
4) clinical evidence of an acute general condition, intoxication or withdrawal
what are the 2 ways in which delirium can present
1) HYPERACTIVE DELIRIUM
- restlessness
- agitation
- heightened arousal
- aggression
2) HYPOACTIVE DELIRIUM
- drowsiness
- increased sleeping
- quiet
- withdrawn behaviour
Medications that can cause delirium (4)
- Corticosteroids
- Drugs with anticholinergic properties
- (sedative drugs) Benzodiazepines
- Opioid analgesics
name some causes of delirium
- constipation
- infection
- electrolyte imbalance
What criteria does “CAM positive” consist of?
1) Acute onset and fluctuating course
2) inattention (counting backwards or decreased attention during review)
3) and either of the following
- disorganised thinking (incoherant disorganised speech)
- altered level of consciousness (hyperalert, hypoalert, or both)
what is the 4AT test?
It is a validated tool used to assess a patient for delirium; shortened version of the AMTS
what does AMTS stand for
abbreviated mental test score
what do the scores for 4AT equate to?
- more than or equal to 4 = possible delirium with or without cognitive dysfunction
- 1-3 = possible cognitive impairment
- 0 = delirium or cognitive impairment unlikely
what are the 4 hallmarks of 4AT?
1) Alertness
2) AMT4
3) Attention
4) Acute + fluctuating course
Assess ALERTNESS on 4AT?
normal and fully alert = 0 clearly abnormal (drowsy or agitated) = 4
Assess AMT4? (4AT)
ask the patient the following questions
1) Age?
2) DoB?
3) Current year?
4) Current location?
0 = no mistake 1 = 1 mistake 2 = 2 or more mistakes
Assess ATTENTION? (4AT)
Ask the patient to name the months backwards starting at December
0 = 7 or more mistakes 1 = less than 7 correct 2= untestable/drowsy
Assess acute and fluctuating course? (4AT)
Yes = 4 No = 0
4 hallmarks for managing delirium?
1) treat underlying course
2) environmental changes
3) pharma measures
4) prevent complications
pharmaceutical measures if the patient remains distressed despite conservative measures?
Haloperidol
(0.5 mg PO or 1 mg IM)
OR Olanzapine
Haloperidol and Olanzapine are contraindicated in which conditions?
- Parkinsonism
- Dementia with Lewy bodies
Medication that can be given to patients with Parkinsonism or Lewy body dementia
Lorazepam
how to treat alcohol withdrawal, as a cause of delirium?
- benzodiazepine
- chlorodiazepoxide
List the first line investigations for a patient presenting with delirium
- blood cultures
- CXR
- MSU analysis
- serum Calcium
- FBC
- U + E
- LFTs
- TFTs
- ECG
- Glucose
- CRP
name the 2nd line tests for a patient presenting with delirium
CT brain
ABG
cultures of; urine, wounds, sputum, blood, CSF
first line management of delirium?
reorientation, reassurement, and treating the underlying cause
delirium leads to:
- increased risk of pressure ulcers and falls
- increased incidence of dementia
- increased rate of admission to long term care
- longer hospital stays
