Delirium and EM pysch Flashcards
other names for delirium
encephalopathy ICU psychosis cerebral insufficiency change in mental status acute brain failure
other names for delirium
encephalopathy ICU psychosis cerebral insufficiency change in mental status acute brain failure
is delirium reversible
yes
characteristic of delirium
fluctuatins (waxing and waning) acute onset (hrs to days) hypoactive, hyperactive or mixed withdrawal and non-withdrawal types signs no accounted for by dementia
major differences of delirium and dementia
delirium has disrupted attention, waxing waning, disorganized speech
dementia attention intact, no waxing waning, poverty of speech
delirium has distrubances where
vital signs consciousness attention and awareness pyschomotor emotional cognitive sleep wake cycle
delirium is significant risk factor for
NCD dementia
prognositc factor of delirium
20-40% mortality in 12 mo
NT changes in delirium
inc DA
dec ACH
what meds can cause delirium
anticholinergics! antiHTN antipsychotic antibiotics antidepressants disulfram, lithium opioids anticonvulsants cytotoxic agents
what metabolic disturbances can cause delirium
post surgery fever anemia deydration hepatic failure hyper/hypoglycemia hyper/hypothyroidism hypoxia/hypercapnia
what infections can cause delirium
UTI URI pneumonia cellulitis sepsis
trauma related causes delirium
head trauma
burns!!
labs to order for delirium
NH3, CBC, UA, CMP, LFTs, EKG, CXR, TSH, Blood gases, LP, CT, MRI etc
how to orient delirious patients
clocks, calendars, family pictures, proper sleep structuring
discontinue what meds in melirium
anticholinergic
all unnecessary meds
which antipsychotics can be used in delirium
low dose
haloperidol
avoid what antipsychotics in delirium
anticholinergic ones like olanzapine and clozapine and chlorpromazine
adverse effects antipsychotics in delirium
prolong QT
dec seizure threshold
when can you use benzos for delirium
ONLY when caused by alcohol or benzo withdrawl
when can you use benzos for delirium
ONLY when caused by alcohol or benzo withdrawal
patients at high risk for delirium
major/mild NCD prev Hx delirium >65 multiple meds substance use sensory impairment
prophylaxis for delirium
haloperidol, 2nd gen antipsychotic
malatonin
gabapentin
lower propofol levels
best predictor for violence
Hx of violence
risk factors violence
command hallucinations stated intend/desire to harm self/others antisocial or borderline personality disorder substance abuse delirium major/mild NCD head trauma
risk factors violence
command hallucinations stated intend/desire to harm self/others antisocial or borderline personality disorder substance abuse delirium major/mild NCD head trauma
managing EM psychiatry
be empathetic and calm speak softly, careful with eye contact validate feelings enforce boundaries in friendly manner watch body language listen!! if needed safely escort to seclusion area
physical restraints
should be removed asap
never used as punishment
can lead to death (suffocation or rhabdomyolysis)
physical restraints
should be removed asap
never used as punishment
can lead to death (suffocation or rhabdomyolysis)
