Delirium

Question 1

Common delirium triggers? (6)

Answer 1

Myocardial infarction
Infection (chest, uti)
Constipation
Post-surgical
Drug toxicity/polypharmacy
Organ failure (e.g. kidney, resp)

Question 2

Components of the confusion assessment method?

Answer 2

1. Acute onset and fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered consciousness

Diagnosis requires 1+2 and one of 3 or 4

Question 3

Factors which predispose to delirium? (5)

Answer 3

Age
sensory impairment
multimorbidity
existing chronic brain disease
use of psychotropic medication

Question 4

Common drug causes of delirium? (3)

Answer 4

Psychotropics
Opiates
Anticholinergics

Question 5

Approach to the management of delirium (4)

Answer 5

Find the cause and treat it
Supportive nursing care
Optimise the environment
Drugs (haloperidol) as a last resort

Question 6

What are the constituents of the 4AT?

Answer 6

Alertness
AMT4
Attention
Acute change or fluctuating course

Question 7

What questions are asked as part of the AMT4?

Answer 7

Date of birth
Age
Current year
Current place

Question 8

What does a score of a) 4 or more b) 1-3 c) 0 on the 4AT indicate?

Answer 8

4- possible delirium
1-3 possible cognitive impairment
0- delirium or cognitive impairment unlikely

Question 9

Preferred drug management in delirium?

Answer 9

Lowest possible dose, shortest possible time- haloperidol or olanzapine

Question 10

Adverse effect/related contraindications to antipsychotic use?

Answer 10

EP side effects; avoid in PD and lewy body dementia

Question 11

Preferred drug management of delirium in patients where antipsychotics are contraindicated?

Answer 11

Benzodiazepine such as diazepam or chlordiazepoxide

Question 12

Complications of delirium?

Answer 12

Hospital acquired infection e.g. C diff, MRSA
Pressure sores
Fractures from falls
Residual impairment
Progression to stupor --> coma --> death