ICS-Delirium Flashcards
End organ dysfunction of the brain
Delirium
Delirium is a what until proven otherwise?
Emergency
Criteria for diagnosis of delirium
Acute onset of disturbance in consciousness (keeps falling asleep) or a disturbance in cognition (confusion) due to underlying medical cause.
Important features associated with delirium
Sleep-wake disturbances, psychomotor disturbance, labile affect, symptoms wax and wane over 24 hours
What patients might you see that will present with delirium 70% of the time?
Cancer patients, ICU (on ventilator)
What people are at higher risk for developing delirium?
Elderly, polypharmacy (benzos, anti-cholinergics) and any condition that damages the cognitive reserve (dementia, MS).
Neurotransmitters involved in delirium
Brain gets damaged and releases dopamine (causes hallucinations), ACh is decreased and focus diminishes.
Things to quickly rule out quickly when patients present with delirium.
Wernicke’s, Hypoxia, Hypoglycemia, hypertensive encephalopathy, meningitis, poisoning, stroke
Medication syndromes that can cause delirium
Serotonin syndrome, anticholinergic delirium, neuroleptic malignant syndrome, malignant hyperthermia.
Serotonin syndrome
Sweaty, big pupils, increased motor tone (myoclonus, hyperactive reflexes), febrile, hyperactive bowel sounds
Anticholinergic syndrome
Dry skin, flush, tachycardia
Neuroleptic malignant syndrome
Use of too much antipsychotic medication. Characterized by high fever, increased rigidity, rhabdomyolysis
Malignant hyperthermia
Febrile, rigid and often post-operative
Why do people often miss delirium?
Previous psychiatric diagnosis
Labs to get for a patient with decreased mental status
CBC, CMP, B12, TSH, UA (looking for urosepsis), fluorescent treponemal antibody (looking for neurosyphilis)
