Delirium Flashcards
Define Delirium.
An acute decline in attention & cognition that initiates a cascade of events.
What are the causes of delirium?
Medication toxicity, infection, fluid/electrolyte disturbance, neurologic, sensory/environmental deprivation.
What medications can cause delirium?
Anticholinergics (antihistamines), sedatives (benzos), immunosuppressants (corticosteroids), opioids (morphine), alcohol.
Features of vulnerable patients: (7)
Demographic features, cognitive status, functional status, sensory impairment, decreased oral intake, drugs, coexisting medical conditions.
Precipitating factors for delirium: (6) (what causes delirium?)
Drugs, primary neurologic disease, illness, surgery, environmental, prolonged sleep deprivation.
Two mechanisms for pathogenesis of delirium:
Cholinergic deficiency and dopaminergic excess.
Key features of presentation of delirium: (10)
Acute onset, fluctuating course, inattention, disorganized thinking, altered LOC, cognitive deficits, perceptual disturbances, altered sleep wake cycle, emotional disturbances, psychomotor disturbances.
How do you screen for delirium? (4)
History, physical exam, neurological exam (LOC, visual fields, sensory testing, CT scan, EEG), and cognitive tests.(MMSE, CAM)
What are the risk factors for delirium? (6)
Cognitive impairment, sleep deprivation, immobility, visual impairments, hearing impairments and dehydration.
What’s the drug of choice for treatment of delirium?
Haloperidol IM (+/- lorazepam)
What’s the drug of choice for treatment of delirium due to alcohol or benzo withdrawal?
Lorazepam IM or IV
How do you monitor for efficacy of Tx in delirium?
Repeat mental status q24h.
Should see response in 20-60min; if no response in 30 min, double dose of haldol
