Lecture 7 - Delirium

Question 1

DSM-IV Criteria for Delirium

Answer 1

1. Disturbance of consciousness
2. Change in cogitation or development of perceptual disturbance
3. Disturbance develops over short period of time and fluctuates through day
4. evidence in history, PE, labs that its caused by a general medical condition

Question 2

Risk factors for Delirium

Answer 2

Age > 65
Moderate-severe dementia
Mod alc use ( > 2/day)
CHF ( 3/4)
COPD
Need for hemodialysis
Withdrawal from alc
HTN

Question 3

Acute disease factors for Delirium

Answer 3

acute stroke
Sepsis/septic shock
Major surgery
Major trauma
High severity of illness

Question 4

hospital factors for Delirium

Answer 4

sedation-induced coma
isolation/no visitors
No daylight
Noise
Restraint use/lack of mobility
Catheteres, tubes

Question 5

Med risk factors for Delirium

Answer 5

Benzo (lorazapema, midazolam)
Corticosteroids (high dose)
Anticholinergics
Metoclopramide
Levetiracetam
Anti infectives w/ good brain pen
Opioids

Question 6

Dr. DRE

Answer 6

D-iseases = Sepsis, CHF, COPD, New organ dysfunction, Hypoxemia
Dr-ug removal = sedative down titration, stop/reduce psycho meds
E-nvironment = immobilization, sleep, noise, hearing aids/glasses

Question 7

Diagnosing Delirium

Answer 7

CAM-ICU
* Most have 1+2, and either 3 or 4

1. acute onset or fluctuating mental status
   2.Inattention = squeeze when hear A, SAVEAHAART
2. Disorganized thinking = 4 Yes/No questions
3. Altered lvl of consciousness

Question 8

ICDSC scores

Answer 8

> 4 is delirium

Question 9

Four Key strategies to reduce ICU Delirium

Answer 9

1. screen critically ill adults regularly and reliably for delirium
2. Recognize and reduce modifiable risk factors for delirium
3. Focus on non-pharm interventions known to reduce delirium that may include use a multimodal protocol
4. generally, avoid pharm interventions to reduce delirium