Delirium Flashcards
(19 cards)
What is delirium?
An acute, fluctuating syndrome of disturbed consciousness, attention, cognition + perception
What is delirium recognised by?
a change in consciousness, either hypo or hyperalert, + inattention
Causes of delirium
THINK DELIRIUM
- Trauma (pain)
- Hypoxia
- Increasing age/frailty
- Neck of femur fracture
- smoKing or alcohol withdrawal
.
- Drugs e.g. opioids, benzos
- Epilepsy / Electrolyte imbalance
- Liver failure / Low oxygen
- Infection e.g. UTI
- Retention (constipation)
- Intracranial e.g. stroke
- Uraemia
- Metabolism e.g. hypoxia
What patients in hospital are at risk of delirium?
- frail patients
- sensory impairment
- cognitive impairment
- having surgery
- hip fractures
- severe infection
What test is used to screen for delirium?
4AT test
(+AMT-4 test)
What makes the 4AT test?
- alertness
- AMT4: age, DOB, location, current year
- attention: list months in reverse from december
- acute change or fluctuating course
Types of delirium + their presentation
-
Hyperactive: agitated, aggressive + delusions
Or - Hypoactive: drowsy + withdrawn
Treatment of delirium
- treat underlying cause
- treat/minimise precipitating factors
- encourage normal day/night cycle
- allow wandering if safe
- involve loved ones
- distraction techniques
- haloperidol as last resort
What medication is used in delirium if non-pharmacological treatments have failed?
Haloperidol
Mechanism of action of haloperidol
typical antipsychotic drug
- blocks dopamine D2 receptor
Side effects of haloperidol
- arrhythmias
- QT interval prolonging
- rash
- constipation/urinary retention
- extrapyramidal symptoms
- anticholinergic effects
Contraindications of haloperidol
- DEMENTIA
- history of ventricular arrhythmias
- history of torsade de pointes
- prolonged QT syndrome
- recent MI
What are extrapyramidal symptoms?
- hyperprolactinaemia side effects
- dystonia
- parkinsonianism
What are hyperprolactinaemia side effects?
- galactorrhoea
- amenorrhoea
- decreased fertility
- ED
- osteopenia/osteoporosis
- reduced libido
What are anticholinergic side effects?
- dry mouth
- confusion
- flushed skin
- hyperthermia
- tachycardia
- dilated pupils
- urinary retention
- absent bowel sounds
What factors suggest a diagnosis of delirium over dementia?
- acute onset
- impairment of consciousness
- fluctuation of symptoms - worse at night
- abnormal perceptions e.g. illusions + hallucinations
- agitation + fear
- delusions
Presentation of hyperactive delirium
- agitated or aggressive
- incoherent speech
- disorganised thoughts
- delusions
- halluciantions
- disorientation
Presentation of hypoactive delirium
- drowsy
- less reactive
- looks withdrawn
Prevention of delirium
- identify people at risk e.g. history, not sleeping well, high opioids for pain
- help them feel orientated + comfortable e.g. glasses on, hearing aids working
- maintain daily a routine
