Cases Flashcards
(37 cards)
What is the triad of delirium tremens?
Delirium
Visual hallucinations
Tremor
What are some of the differentials for delirium tremens?
Could be a stroke
Infection e.g. sepsis
Dementia (lewy body - hallucinations)
What could contribute to delirium?
New environment New people in hospital - staff and patients Lack of sleep Natural lighting Medication - can cause delirium Hyponatraemia Dehydration Do they have glasses Do they have hearing aids
How do you score delerium tremens?
CIWA - Clinical institute withdrawing from alcohol
What are some of the symptoms included in the CIWA score?
Sweating Visual hallucinations Tactile hallucinations Headache Anxiety Aggitation
What is benzodiazepine that is used for the treatment of delirium tremens? When should this not be used?
Chlordiazepoxide
Should not use in liver disease as renally secreted, can use lorazepam instead
How should delirium tremens be treated?
Chlordiazepoxide
IV pabrinex - to treat Wernicke-korsakoff’s
Diazepam in seizures
Clocks and windows to allow them to orientate themselves
What is a good way to open a dialogue with a patient that has hallucinations?
Asking how they make them feel, say that it sounds really scary
What is wernickes triad?
Ataxia
Opthalmoplegia
Confusion
How would you ask about alcohol addiction?
CAGE Considered cutting down Annoyed about other people critisising drinking Guilty Eye opener
How would you ask about alcohol dependence?
DSM IV alcohol dependence syndrome questions
Tolerance
Withdrawl
Activities - given up due to alcohol
What help do you offer people who are about to be discharged with alcohol dependence?
Bio - acamprosate - helps block brain signalling in withdrawl
Psycho - addiction psychiatry can be referred to, CBT, councelling
Social - Aqerius or AA - if homeless then need housing support
How would you assess competence for an individual with delirium tremens?
Determine if they are:
- taking in the information
- Weighing up the decision
- Making a decision
- Communicating a decision
How do you detain someone under the mental capacity act?
DOLS
Deprivation of Liberty safeguards
What are the main questions for differentiating generalised anxiety disorder and PTSD?
Asking what they are anxious about
Sleep disturbance - nightmares vs depression
For a panic attack what should you ask patients about?
Physical : -Hyperventialation -Tachycardia -Sweating -Central crushing chest pain -Dizziness Psychological: -Feel like they are going to die -Fight or flight response -out of body experience
What are the requirements for PTSD?
Need a traumatic events 4-6 weeks following event Flashbacks Avoidance Hyperarousal
What is the management of PTSD?
Bio - SSRIs are used with Paroxetine being first line
Zopiclone can be used for sleeping until SSRIs start working
Psyc - eye movement desensitisation, CBT
How does eye movement desensitisation work?
They do this following CBT when they have come to terms with event itself
During the eye movement desensitisation they read a script of the event to retrigger the memory and then they move their eyes from left to right following a que, this helps to desensitise them
What could be a differential of anorexia with no insight?
Could be a first episode psychosis
What are the effects on the body of starvation?
Hair falls out - grow thin hair
Cardio - palpatations, faintness
What are the ecg changes with anorexia?
Inverted T waves with hypokalaemia
Prolonged qt from hypocalcaemia
What tests are done for anorexia?
Sit up, squat and stand tests
Tests core muscle mass for being able to stand up without hands
What do you test for risk of refeeding syndrome?
Phosphate, if it starts to fall then stop refeeding
