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