geriatrics: ixs Flashcards
screening tool for delirium
and what score equals possible delirium
4- AT score
- alertness (4)
- AMT4 (Age, date of birth, place current year) (2)
- attention (2)
- acute change or fluctuating course (4)
> 4 = possible delirium
how to diagnose delirium
The Confusion Assessment Method (CAM)
requires the presence of features 1,2 and either 3 or 4:
1: acute onset and fluctuating course
2: inattention
3: disorganised thinking
4: altered level of consciousness (eg. drowsy, hyper alert etc)
pharmacological management of agitation, when to use and contraindications
- when non pharmacological methods have failed
-symptoms threaten safety of patient or to others/ sig fig distressing psychotic symptoms
1st line: haloperidol 500mcg orally (preferably) or IM
DO NOT USE IN HISTORY OF PARKINSONS OR LEWY BODY DEMENTIA
pharmacological mx of agitation in those with parkinsons/lewy body dementia
lorazepam 500mcg- 1mg oral
(remember this is last resort)
what assessments should always be done on a patient admitted with fall
4AT, MMSE/MOCA
to assess cognitive impairment/dementia
what is a positive finding of carotid sinus syndrome
results of carotid sinus massage:
cardio-inhibitory CSS- pause in hr > 3 seconds
vasodepressor css- drop in systolic bp of 50mmhg
mixed css- simultaneous combination of both
contraindications to carotid sinus massage
MI or CVA in last 3 months, hx of VT, carotid artery stenosis
if Carotid sinus massage negative?
consider tilt table CSM
what bp is associated with increased risk of falls
systolic 120 or below
what anti-hypertensives should u avoid stopping in elderly for falls
ACEIs and beta blockers
confirmation of death criteria (5)
absence of carotid pulse over one minute confirmed
&
absence of heart sounds over one minute confirmed
&
absence of respiratory sounds/effort over one minute confirmed
&
no response to painful stimuli (eg trapezius squeeze)
&
fixed dilated pupils (unresponsive to bright light)
drugs affecting renal function
morphine, anitbiptocs, ace
short term anti-cholinergic side effects
Confusion and hallucinations
Tachycardia
Blurred vision
Urinary retention
Constipation
Dizziness
long term anti cholinergic side effects
inc risk of developing dementia
bleeding stomach ulcer stop…
NSAID
