Delirium Flashcards
(30 cards)
What is delirium?
Acute deterioration in mental functioning,
arising over hours or days,
triggered mainly by acute medical illness, surgery, trauma or drugs
Risk factors for delirium? (10)
elderly, pre-existing cognitive impairment, post-op, sensory impairment e.g. deaf/blind, previous Hx of delirium, drug/alcohol dependence, depression, polypharmacy, multiple co-morbidities e.g. Parkinsons, CVD, ICU admission
Features of delirium?
acute onset, fluctuating course, altered conscious levels (hyper/hypo), inattention/decreased awareness, disorganised thinking
Assessment of delirium?
4AT or CAM (Confusion Assessment Method),
TIME bundle
Basis of management of delirium?
Identify and treat underlying cause
What neurotransmitter is particularly deranged in brain in delirium?
ACh
Common causes of delirium? (8)
infection, e.g. chest, urinary tract, dehydration, fever, polypharmacy, hip fracture, constipation, fluid overload, catheterisation
DELIRIUM mnemonic causes
Drugs, Electrolyte disturbance e.g. hyponatraemia, Lack of drugs (alcohol withdrawal), Infection, Reduced sensory input, pain, Intracranial e.g. stroke/subdural, Urinary retention/constipation, Metabolic e.g. AKI, hypoglycaemia, hypothyroid, B12/folate, calcium
How does dementia differ to delirium in terms of onset, course, duration, activity, alertness, attention, mood, thinking, perception?
Dementia: slow, progressive, months to years, wandering/agitated, generally alert, normal attention, low mood, word-finding difficulties, usually normal perception,
Delirium: sudden, short & fluctuating, hours to less than month, restless/agitated (hyper) or sleepy/slow (hypo), fluctuating alertness, impaired attention, fluctuating emotions, disorganised thinking, distorted perception
Which type of delirium is harder to diagnose and has twice the mortality rate?
Hypoactive delirium harder to diagnose and twice mortality rate
Who should be screened for delirium?
All patients >65 years on admission to hospital
4AT components?
Alertness,
AMT4 (Orientation) (age, DOB, place, current year),
Attention (months of year from December backwards),
Acute change or fluctuating course
4AT scores parameters
4 or > - possible delirium +/- cognitive impairment,
1-3 - possible cognitive impairment,
0 - delirium or severe cognitive impairment unlikely
What is the TIME bundle?
Think triggers,
Investigate and intervene,
Manage,
Explain
What examination is particularly important for delirium?
Neuro!!
What is T in Time bundle?
Think triggers -> SEWS, BG, meds history, alcohol history, urinary retention, constipation, pain review
What is I in Time bundle?
Investigation and intervene -> assess hydration, bloods, look for infection signs, ECG i.e. do NEWS score and intervene asap
Investigations for delirium?
Bloods (FBC, U&Es, LFTs, CRP, Ca, B12/folate, Mg, TSH, glucose),
culture if septic,
ECG,
Imaging depending on presentation (bladder scan, CT head if focal neurology)
A review of what is very important in delirium?
Medication!!
First line management for agitation in delirium is non-pharmacological. What is this?
reassurance,
reorientation,
optimisation of sensory input e.g. make sure can hear and see
If medication required for agitation in delirium, what is first line after non-pharmacological measures?
haloperidol (less S/E than Benzos)
What charts should be kept for delirium patient management?
Food chart,
fluid chart,
bowel chart
If medication required for agitation in delirium, what is first line after non-pharmacological measures?
haloperidol 500mcg oral,
if not oral then 500mcg IM
What 3 charts should be kept for delirium patient management?
Food chart,
fluid chart,
bowel chart
