Delirium and EM pysch

Question 1

other names for delirium

Answer 1

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

Question 2

other names for delirium

Answer 2

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

Question 3

is delirium reversible

Answer 3

yes

Question 4

characteristic of delirium

Answer 4

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

Question 5

major differences of delirium and dementia

Answer 5

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

Question 6

delirium has distrubances where

Answer 6

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

Question 7

delirium is significant risk factor for

Answer 7

NCD dementia

Question 8

prognositc factor of delirium

Answer 8

20-40% mortality in 12 mo

Question 9

NT changes in delirium

Answer 9

inc DA

dec ACH

Question 10

what meds can cause delirium

Answer 10

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

Question 11

what metabolic disturbances can cause delirium

Answer 11

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

Question 12

what infections can cause delirium

Answer 12

UTI
URI
pneumonia
cellulitis
sepsis

Question 13

trauma related causes delirium

Answer 13

head trauma

burns!!

Question 14

labs to order for delirium

Answer 14

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

Question 15

how to orient delirious patients

Answer 15

clocks, calendars, family pictures, proper sleep structuring

Question 16

discontinue what meds in melirium

Answer 16

anticholinergic

all unnecessary meds

Question 17

which antipsychotics can be used in delirium

Answer 17

low dose

haloperidol

Question 18

avoid what antipsychotics in delirium

Answer 18

anticholinergic ones like olanzapine and clozapine and chlorpromazine

Question 19

adverse effects antipsychotics in delirium

Answer 19

prolong QT

dec seizure threshold

Question 20

when can you use benzos for delirium

Answer 20

ONLY when caused by alcohol or benzo withdrawl

Question 21

when can you use benzos for delirium

Answer 21

ONLY when caused by alcohol or benzo withdrawal

Question 22

patients at high risk for delirium

Answer 22

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

Question 23

prophylaxis for delirium

Answer 23

haloperidol, 2nd gen antipsychotic
malatonin
gabapentin
lower propofol levels

Question 24

best predictor for violence

Answer 24

Hx of violence

Question 25

risk factors violence

Answer 25

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

Question 26

risk factors violence

Answer 26

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

Question 27

managing EM psychiatry

Answer 27

``` 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 ```

Question 28

physical restraints

Answer 28

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

Question 29

physical restraints

Answer 29

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