Delirium Flashcards Preview

Internal Medicine > Delirium > Flashcards

Flashcards in Delirium Deck (10):
1

Definition

Acute fluctuating change in LOC with inattention, disorganised thinking, cognition, perception

1. Disturbance in attention->inability to sustain or change
2. Change in cognition, or perceptual disturbance
3. Occurred over a short period of time, change from baseline, fluctuating
4. Direct physiological consequence of a GMC/substance and not occurring when only in coma

2

Pathophysiology

Unknown mechanism
1. Neurotransmitter->anticholinergic, +dopamine
2. Inflammation
3. Chronic stress->++cortisol

3

Etiology

1. Cardiovascular: MI, hypoxia
2. Neurological: meningitis/encephalitis, tumor, post-ictal, stroke, Wernickes
3. Kidney: failure, urinary obstruction
4. Liver: hepatic encephalopathy
5. Endocrinology: hypo/hyperglycemia, hypercarbia, alcoholic ketoacidosis, hyponatremia, hypercalcemia, thyrotoxicosis
6. Dehydration
7. Constipation
8. Drug intoxication/withdrawal
9. Sepsis

4

History

1. Medication review
2. Previous cognitive status
3. Co-morbidities
4. Pain
5. Alcohol and drug
6. Environmental

5

Physical examination

1. Vitals
2. Hydration
3. Pupils->drugs, W/D, CVA, +ICP
4. Lung examination: infection, CHD, COPD
5. CV->CAD, MI
6. Abdominal: intra-abdominal infection, constipation
7. Suprapubic tenderness->UTI, obstruction
8. Hip tenderness
9. Neurological
10. Mental status examination

6

Initial investigations

FBC
UEC
LFTs
ABG
Glucose
Urinalysis
CXR
ECG
Drug levels

7

Further investigations

CT/MRI
LP
EEG->generalised slowing

8

Management

1. Identify and treat underlying cause
2. Medication review
3. Non-pharmacological
4. Pharmacological

9

Non-pharmacology approach

1. Continuous observation
2. Monitoring vital signs
3. Keep oriented, quiet, calm environment
4. Hydration, analgesia, nutrition
5. Approach from the front

10

Medication if required

1. Thiamine (before glucose) if suspect alcohol component
2. Haloperidol OR olanzepine OR risperidone
3. If EPSE->bentripine