Lecture 24 - Delirium Flashcards Preview

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Flashcards in Lecture 24 - Delirium Deck (16):
1

what is the basic definition of delirium and how does this compare to dementia?

ACUTE BRAIN FAILURE vs (dementia (chronic bran failure))


§ Overall -- psychiatric manifestations of acute loss of attention and awareness that is caused by another medical condition, substance

2

DSM Criteria for Delirium Dx

○ Disturbance in attention and awareness , which tends to fluctuate in severity throughout the course of the day

§ Develops over short period of time

○ + Additional disturbance in cognition

○ Not better explained by another pre-existing neurocognitive disorder


Evidence (History, Physical, labs) that the disturbance is a direct physiological consequences of another medical condition, substance intoxication or withdrawal, exposure to a toxin

3

what are 2 subtypes of delirium

Hyper and Hypoactive

4

how is attention deficit assessd?

what other changes in cognition might be present?

Mini Mental, MoCA, serial 7s, clinically

Memory, disorientation, language, apraxia, halluciations

5

how common is delirium


who is at higher risk?

• Vey Common
• 6-56% in hospitalized Patients;
• 1/3 and 2/3s of cases are missed


Risk: post cardiotomy, burns, elderly, terminal cancer, ICU,

6

Describe the general pathophysiology ---


what brain sturcutres are affected first?

Inadequate oxidative metabolism

○ Demand often increases in illness


○ Brain structures - first affected
§ hippocampus
§ Neocortex

7

which NT is most implicated with Delirum


○ The NTs
§ Reduction in Cholinergic Activity --
□ Excess Dopamine may be harmful

8

Complicatins of delirium?

Agitation
Injuries

Increased length of stay

9

• Emergency Etiologies to rule out at the bedside

what is the triad for wernicke's

what drugs implicated for withdrawal?


WWHHHIMP

Wernicke’s (Delirium, Ophthalmoplegia (can't look laterally), Ataxia )

Withdrawal (ETOH, Barbs, Benzo)

Hypertensive
Hypoglycemia
Hypoperfusion
Intracranial bleed
Meningitis
Poisons

10

Other etiologies ?

Drug Intox
Infection
Trauma
Cancer
Paraneoplastic Syndrome

11

what medications are particularly deliriogenic?

Anitcholinergics

MEPERIDINE (normeperidine metabolite is very deliriogenic)

12

what is the mortality for a delirious patiet?

40% die within 1 year of dx

13

when do you image?

if there is no obvious cause of the dementia

14

Treatment of dilirum?

• Treating the etiology -- eg the the HTN or the PNA


• Nonspecific Treatment for Delirium --
Medical -- frequent vitals, check fluids, maintain nutrition,

Psychosolcal
Environmental
Pharmacological -- Hloperidol,

15

when are benzodiazepines used for treatment of delirium?

ONLY FOR WITHDRAWAL DELERIUM

16

evidence for prevention

• Prophylaxis -- small dose antipsychotic for elderly or high risk going to elective surgery, can reduce delirum

• Choice of Post Operative Sedation agent -- Propofol (50%), Midazolam (50%), Dexmedetomidine (3%)