Acute confusion Flashcards
What is the summarised version of patients’ medical records called?
Patient summary or transfer of care document.
Which information is included in the transfer of care document?
- Patient name, age, address, phone number, emergency access details (e.g. key code entry), next of kin information
- Significant diagnoses*
- Repeat medications list and allergies
- Acute medications prescribed in the last 6 months
- Details of any consultations in the last 6 months
- Recent investigation results such as blood pressure, blood test results, imaging
- Type of care home (residential or nursing, specialised dementia unit) as well as the level of training of the care staff.
What should the GP do before doing a home visit?
Before visiting, the GP would typically phone ahead. This is to gather more information and ensure that all the information and equipment is taken on the visit.
Why is it important to call before going for a home visit?
Occasionally issues can be dealt with over the phone and do not require a visit. Alternatively, the GP can sometimes determine that the patient needs 999 ambulance rather than waiting for a visit or can determine the clinical need of patients and prioritise visits.
How do GP practice prioritise urgent cases?
Some practices will have a dedicated triaging system for urgent appointments and home visits. This will involve a doctor or senior nurse conducting telephone triage to help filter urgent from less urgent problems.
What can a GP do to stop medication in the doctor’s bag from expiring?
It’s the GP’s responsibility to ensure the medications are in date so it can useful to set an alarm reminder on the computer system to review the contents at the next medication expiry date, or have systems within the practice where all the GP bags and medications are checked at regular intervals.
What is delirium?
Delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking, and altered levels of consciousness.
This is a potentially life-threatening disorder characterised by high morbidity and mortality.
Which clinical features should be considered before diagnosing a patient with delirium according to DSM-5?
A disturbance in attention (i.e., reduced clarity of awareness of the environment) is evident, with reduced ability to focus, sustain, or shift attention.
A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance not better accounted for by a pre-existing or evolving dementia.
The disturbance develops over a short period of time (usually hours to days), represents an acute change from baseline, and tends to fluctuate during the course of the day.
There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition, substance intoxication, or substance withdrawal.
What are the risk factors for delirium?
Older age Male sex Dementia or cognitive impairment Severity of dementia Severe comorbidity Visual or hearing impairment Functional impairment or immobility Social isolation Stress Movement to a new environment History of delirium Decreased oral intake (e.g., dehydration) Polypharmacy and drug use such as benzodiazepines Co-existing medical illness Physical frailty Surgery.
What precipitating insults can cause delirium?
Drugs
Primary neurological injury
Acute illness
Metabolic abnormalities such as hypoxia, hyponatraemia, hypercalcemia, hypoglycaemia.
Surgery
Endocrinopathies
Vitamin deficiencies such as thiamine, B12 and nicotinic acid
Environmental factors
Pain
Prolonged sleep deprivation
Drug withdrawal: benzodiazepines, alcohol
What are examples of drugs that can cause delirium?
Sedatives, narcotics, anticholinergics, multiple drug use, and alcohol, as well as overdose of tricyclic antidepressants, stimulants, opiates, corticosteroids, analgesics, cardiac glycosides, and anti-Parkinson’s drugs.
What are examples of primary neurological injury that can cause delirium?
Stroke, intracranial bleeding, meningitis, encephalitis, subdural haemorrhage, SLE, cerebral venous thrombosis.
What are examples of acute illness that can cause delirium?
Infection (e.g., pneumonia, urinary tract infection, sepsis), cardiac illness (e.g., myocardial infarction), hypoxia, shock, dehydration, fever, constipation, iatrogenic complications, cerebral abscess and malaria.
What are examples of environmental factors that can cause delirium?
Use of physical restraint, use of catheters/invasive monitoring, intensive care unit stay.
What are the red flags condition causing delirium?
- Acute stroke
- TIA
- Subdural haematoma
- Epilepsy
- Meningitis
- Encephalitis
- Brain abscesses
- Neurosyphilis
- MI
- UTIs and pneumonia- delirium is usually the only identifiable sign in older people.
- Sepsis
- Hypoxia due to PE, sepsis, severe asthma attack, COPD, cardiac failure or arrhythmia, CO poisoning.
- PE
- Alcohol ketoacidosis (Wernicke’s encephalopathy and Korsakov’s psychosis)
- Metabolic abnormalities
- Hypoglycaemia/hyperglycaemia
- Overdoses with anticholinergics, TCA, stimulants, opiates, corticosteroids, analgesics, cardiac glycosides.
- Drug withdrawal
- Myxoedema coma
- Addisonian disease
