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Y3M - Older Persons Medicine > Delirium > Flashcards

Flashcards in Delirium Deck (17)
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1

Consequences of delirium.

Increased mortality

Increased length of stay

Worse recovery of underlying illness

More complications

increased risk of developing dementia

2

What is delirium?

An acute confusional state with a sudden onset and fluctuating course.

It develops over 1-2 days and is recognised by a change in consciousness, either hyper, hypo or inattention.

3

Clinical features of delirium.

Globally impaired cognition, perception and consciousness developing acutely 1-2 days.

Marked memory deficity

Disorientation in room and thoughts

May have tactile or visual hallucinations.

4

Types of delirium.

Hyperactive 

Hypoactive

Mixed

5

Explain hyperactive delirium.

Restlessness

Mood lability

Agitation

Aggression

6

Explain hypoactive delirium.

Slow and withdrawn

Drowsy

7

Risk factors of delirium.

>65 yo

Dementia or previous cognitive impairment

Hip fracture

Acute illness

Psychological agitation like pain

8

Give causes of delirium.

Drugs

Epilepsy/Electrolyte imbalance

Liver failure/Low O2 (PE/MI)

Infection

Retention (urinary/faecal)

Intracranial

Uraemia

Metabolism (thiamine, nicotinic acid, B12 def.)

 

also...

Surgery

Systemic infections UTI is a big one

Alcohol withdrawal

Drug withdrawal (opiates, levodopa, sedatives and recreational)

Trauma

 

9

Differentials of delirium.

Dementia

Anxiety

Epilepsy

Primary mental illness can mimic delirium

10

Investigations of delirium.

Look for the cause.

Bloods - FBC, U&Es, LFTs, blood glucose, ABG, septic secreen (urine dipstick, CXR, blood cultures)

ECG

Malaria film

LP

EEG

CT

11

Diagnostic criteria of delirium.

Disturbance of consciousness;
- Decreased clarity of awareness of environment
- Decreased ability to focus, sustain or shift attention

Change in cognition such as memory deficitt, disorientation, language disturbance, perceptual disturbance.

Disturbance develops over a short period (hours or days)

Fluctuation over the course of a day.

12

Non-pharmacological management of delirium.

Reorientate the patients - Explain where they are and who you are at each encounter.

Encourage visits from friends and family

Monitor fluid balance and encourage oral intake

Mobilise and encourage physical activity

Practise sleep hygiene

Avoid or remove catheters, IV cannulae etc...

Watch out for infections

Review medications.

13

Pharmacological management of delirium.

Treat underlying cause obviously.

Sedatives;

Haloperidol 0.5-2mg
Chlorpromazine 50-100mg PO, IM if not PO.

Wait 20 min to judge effect.

Avoid chlorpromazine in the elderly and in alcohol withdrawal.

Avoid antipsychoicts in those with Parkinsons and Lewy body dementia.

14

Sedatives are not always used.

When are they used?

Only used if the patient is a risk to their own or other patient's safety.

15

Screening tools of confusion.

–AMT4 (good for quick assessments e.g. AE)

–AMT 10 (if less than 8 then CAM/4AT) - Used on admission

–CAM – Confusion Assessment Method

–4AT (emerging as favourite tool)

–SQiD - Single Question in Delirium – Is the person more confused or more withdrawn than normal?

16

4AT score

17