what is delirium?
acute deterioration in mental functioning arising over days or hours
how long can delirium last?
days - months
name five risk factors for delirium
elderly cognitive impairment sensory impairment previous history of delirium depression
what is the mnemonic for causes of delirium and what does this stand for?
drugs electrolyte disturbances lack of drugs (withdrawal) infection reduced sensory input intracranial urinary retention metabolic
describe the onset and course of delirium
describe the cognitive effects of delirium
altered conscious level
what are the two types of delirium?
describe the presentation of hyperactive delirium
patients are agitated, aggressive and wander
which type of delirium is easier to diagnose?
describe the presentation of hypoactive delirium
patients are withdrawn, apathetic and sleepy
which type of delirium has a higher mortality?
twice that of hyperactive
which patients should be screened for delirium on admission to hospital?
all patients >65
what is the recommended screening tool for delirium and what score is suggestive of delirium?
what is the next step after screening for delirium if they meet the criteria?
what is involved in a TIME bundle for delirium?
T = think, exclude + treat triggers I = investigate and intervene to correct causes M = management plan E = engage and explore
what examinations should be performed in the investigation of delirium?
what needs to be reviewed when investigating patients with delirium?
what bloods should be done when a patient has delirium?
glucose, FBC, U+E, LFTs, CRP, calcium, B12/folate, Mg, TSH
cultures if septic
what non-pharmacological management can be done for delirium?
optimise underlying chronic disease
activity, food, fluid and bowel charts
when should pharmacological management of delirium be considered?
non-pharm methods have failed
symptoms threaten theirs/others safety
significantly distressing psychotic symptoms
what is the first line management of delirium?
haloperidol 500mcg orally/IM if unable to take oral
when should haloperidol not be given as first line for delirium and what is the alternative?
history of parkinson’s or Lewy body dementia
lorazepam 500mcg-1mg oral