Delirium

Question 1

Three hallmarks of delirium

Answer 1

• Cognitive impairment
• Impaired attention
• Fluctuating course

Question 2

Asterixis

Answer 2

Form of negative myoclonus or loss of tone in the wrist extensors in a rhythmic pattern

Results in an apparent “wrist flapping” motion

Hallmark of metabolic encephalopathies of various etiologies

Question 3

__% of patients will experience delirium near the time of death

Answer 3

80% of patients will experience delirium near the time of death

Question 4

Physical exam tests of attention

Answer 4

Words backwards

Serial sevens

Days of week backwards

Question 5

When should you obtain an ABG as part of your initial workup of delirium?

Answer 5

In any patient with a history of lung disease or a sigificant smoking history

To rule out hypercarbic encephalopathy or hypoxia

Question 6

Treatment for delirium

Answer 6

• Dependent on etiology, most directed towards symptoms of agitation, hallucinations, paranoia
• 1st line: Conservative anti-delirium measures
• 2st line: Pharmacologic solutions
  
  • Atypical antipsychotics (quetiapine, risperidone)
  • Neuroleptics (haloperidol)
• Benzodiazepines are occasionally used, but should be used with caution as they may also precipitate delirium in elderly patients