Delirium Flashcards
define delirium
acute deterioration in mental functioning over hours, triggered by acute illness, trauma or drugs
list some risk factors for delirium
elderly pre-existing cognitive impairment history of delirium sensory impairment use of anaesthesia in surgery drug/alcohol dependence depression polypharmacy
list some causes of delirium
infection fractures hospital admission dehydration/poor nutrition constipation fluid overload urinary retention
what are the clinical features of delirium
acute onset
fluctuating course - dementia is progressively worse
altered conscious level - hypo or hyper active
inattention
disorganised thinking - confusion
none of these features are explained by another condition
describe hyperactive delirium
agitated
aggressive
wandering
easy to diagnose
describe hypoactive delirium
sleepy
not eating much
easy to miss, twice the mortality
what screening tool is used to assess a patient for potential cognitive impairment
4AT
describe the components of the 4AT
alertness - are they awake, sleepy, very abnormal
AMT - can they state age, dob, place, current year
attention - state the months of the year backwards
acute change/fluctuating - significant change
a 4AT score of what is potentially suggestive of delirium
4 or more
describe a TIME bundle
T - think of triggers
I - investigate and intervene
M - management
E - engage and help family
list some potential investigations for delirium
history + collateral history neuro exam basic obs and NEWS blood glucose medication review baseline bloods inc CRP, calcium, B12, folate ECG bladder scan
outline the non-pharmacological management of delirium
optimise chronic disease management
correct sensory input with glasses and hearing aids
food and fluids charts
bowel charts to prevent constipation
reorientate patient with clock and buzzer
when is pharmacological management of delirium indicated
when non-pharmacological management has failed to control symptoms
the patient is unsafe to themselves or others
outline the pharmacological management for delirium
1st line is 500mcg haloperidol orally
2nd line is benzodiazepines or in a patient with history of Lewy Body dementia or Parkinson’s disease
