Neuro - OSCE - Delerium

Question 1

Scoring systems to assess confusion/agitation

Answer 1

RASS - Richmond Agitation Sedation Scale

RSS - Ramsey sedation scale

Question 2

How to do RASS

Answer 2

Observe patient

Look at the positive side of the scale

0 alert and calm, 1 restless, 2, agitated, 3 very, 4 combative

If not alert, say their name, ask to open eyes and look at me

Awake, eye opens, and eye contact >10 = -1
Aware eye opens, non sustained contact = -2
Responds but no eye contact -3

If not respond to voice
Shake shoulder or eternal

Any movement - 4
No response - 5

Question 3

Features of CAM-ICU

Answer 3

1 is there an acute change or fluctuation in mental state

AND

Test for inattention (2 errors)

AND

RASS (if not 0 , POSITIVE)
Anything else

Disorganised thinking test
2 or more errors

Question 4

Define delierium

Answer 4

Disturbance of conscious with a change in cognition over a short period of time

Acute change in mental status with fluctuating course, inattention, altered conscious, disorganised thinking.

Question 5

Classify delirium

Answer 5

Mixed

Hyper active

Hypoactive

Question 6

Risks of delierum

Answer 6

Patient - old age, depression, alcohol, hypertension, visual/hearing, cognitive impaired, pain

Illness - anaemia, acidosis, metabolic disturbance, hypotension, sepsis

Iatrogenic - sleep disturbance, immobile, meds (benzo, anticholionergics, opioids)

Question 7

Management delierium

Answer 7

Prevention and Address risk factors
Regular sedation holds and good sleep hygeine
Sleep wake cycles
Regular orientation, pictures family
Visual/hearing aids

Meds
Haolperidol (Careful QT). No role in prophylaxis (HOPE ICU trial)
Olanzepine
Avoid Benzos

Question 8

Problems with ICU delierium

Answer 8

Increased mortality
Increased number of days on vent
Increased LOS

Long term cognitive impairment
RIsh of self extubation