Delirium and EM pysch Flashcards Preview

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Flashcards in Delirium and EM pysch Deck (29):
1

other names for delirium

encephalopathy
ICU psychosis
cerebral insufficiency
change in mental status
acute brain failure

2

other names for delirium

encephalopathy
ICU psychosis
cerebral insufficiency
change in mental status
acute brain failure

3

is delirium reversible

yes

4

characteristic of delirium

fluctuatins (waxing and waning)
acute onset (hrs to days)
hypoactive, hyperactive or mixed
withdrawal and non-withdrawal types
signs no accounted for by dementia

5

major differences of delirium and dementia

delirium has disrupted attention, waxing waning, disorganized speech
dementia attention intact, no waxing waning, poverty of speech

6

delirium has distrubances where

vital signs
consciousness
attention and awareness
pyschomotor
emotional
cognitive
sleep wake cycle

7

delirium is significant risk factor for

NCD dementia

8

prognositc factor of delirium

20-40% mortality in 12 mo

9

NT changes in delirium

inc DA
dec ACH

10

what meds can cause delirium

anticholinergics!
antiHTN
antipsychotic
antibiotics
antidepressants
disulfram, lithium
opioids
anticonvulsants
cytotoxic agents

11

what metabolic disturbances can cause delirium

post surgery
fever
anemia
deydration
hepatic failure
hyper/hypoglycemia
hyper/hypothyroidism
hypoxia/hypercapnia

12

what infections can cause delirium

UTI
URI
pneumonia
cellulitis
sepsis

13

trauma related causes delirium

head trauma
burns!!

14

labs to order for delirium

NH3, CBC, UA, CMP, LFTs, EKG, CXR, TSH, Blood gases, LP, CT, MRI etc

15

how to orient delirious patients

clocks, calendars, family pictures, proper sleep structuring

16

discontinue what meds in melirium

anticholinergic
all unnecessary meds

17

which antipsychotics can be used in delirium

low dose
haloperidol

18

avoid what antipsychotics in delirium

anticholinergic ones like olanzapine and clozapine and chlorpromazine

19

adverse effects antipsychotics in delirium

prolong QT
dec seizure threshold

20

when can you use benzos for delirium

ONLY when caused by alcohol or benzo withdrawl

21

when can you use benzos for delirium

ONLY when caused by alcohol or benzo withdrawal

22

patients at high risk for delirium

major/mild NCD
prev Hx delirium
>65
multiple meds
substance use
sensory impairment

23

prophylaxis for delirium

haloperidol, 2nd gen antipsychotic
malatonin
gabapentin
lower propofol levels

24

best predictor for violence

Hx of violence

25

risk factors violence

command hallucinations
stated intend/desire to harm self/others
antisocial or borderline personality disorder
substance abuse
delirium
major/mild NCD
head trauma

26

risk factors violence

command hallucinations
stated intend/desire to harm self/others
antisocial or borderline personality disorder
substance abuse
delirium
major/mild NCD
head trauma

27

managing EM psychiatry

be empathetic and calm
speak softly, careful with eye contact
validate feelings
enforce boundaries in friendly manner
watch body language
listen!!
if needed safely escort to seclusion area

28

physical restraints

should be removed asap
never used as punishment
can lead to death (suffocation or rhabdomyolysis)

29

physical restraints

should be removed asap
never used as punishment
can lead to death (suffocation or rhabdomyolysis)