Post-OP Delirium Flashcards
How often does it happen in the elderly?
15%
Main types
Hypoactive (most common)
Hyperactive (most recognised)
Mixed agitation
Difference between delirium and dementia
Risk factors
Age >65y
Multiple comorbidities
Underlying dementia
Renal impairment
Male gender
Sensory impairment like visual or hearing
Common causes
Hypoxia post-op
Infection lik UTI or LRTI
Drug induced like benzo, diuretics, opioids, steroids
Drug withdrawal of alcohol or benzo
Dehydration or pain
Constipation or urinary retention
Electrolyte abnormalities like low Na, high NA or high Ca2+
Key features of assessment
Onset and course of confusion
Symptoms of a possible underlying cause
Co-morbidities and previous baseline cognition
Previous episodes
Drug history including alcohol intake.
What examinatory tests should be carried out?
Abrreviated mental test (AMT) or mini-mental state examination.
This can quantify the current cognitive function allowing for a comparison between previous AMTs or MMSE scores.
Confusional assessment method (CAM) can also be done.
What else should be looked out for in delirium?
Review observations
Drug chart
Check if there are any signs of infection or pain
Check for signs of constipation or urinary retention.
Also do a neurological examination to rule out underlying stroke or subdural haematoma.
Content of AMT
Investigations
Confusion screen:
Bloods - FBC, U&Es, Ca2+, glucose and TFTs
B12 and folate might be requested as well.
Blood cultures and/or wound swabs
Urinalysis and/or CXR
CT head if relevant
Management
Treat underlying cause
Have the patient in an appropriate enviroment which should preferrably be a quiet area, regular routines and clocks to orientate the patient in time and place.
Regular sleeping patterns promoted
Encourage oral fluid intake
Provide analgesia and monitor bowels.
Should sedatives be used?
Sparingly
Haloperidol is 1st line if needed, but lorazepam might be required especially in the elderly.
