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DELIRIUM

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tomi1's version from 2017-02-13 20:45

Section 1

Question Answer
define delirium acute fluctuation in LOC,cognition and attention
prevelance15% in patients -higher elderly- esp post op/pre-death
complicationsearly mortality, prolonged hospitalisation, pressure sores,dementia, ITU
presentation hyperactive deliriumaggressive, stimuli sensitive, psychotic,loud
presentation hypoactive delirium lethargic,slow,quiet, poverty of speech, withdrawn
memorize

Section 2

Question Answer
causes of DELIRIUM Drugs, electrolyte disturbance, level of pain, infection (post op), RF (high CO2,low O2), Impacted faeces (constipation), ,Urinary retention,Metabolic (MI,DM,liver or kidney)
NERUO drugs causing deliriumAED,L-dopa
PSYCH drugs causing delirium ALL= antidepressants, lithium, anxiolytics
PAIN drugs causing delirium opiates,corticosteroids,antihistimines
drugs causing delirium think psychaitric, neuro and pain related medications
commonly missed causes of delirium chest infection, lack of sleep, constipation, urinary output
memorize

Section 3

Question Answer
triggers for delirium CNS=stroke GI=bleed,constipation, urinary retention CHEST=infection,RF HEART=MI LIFESTYLE
environmental triggersmoving around hospital, no watch, no hearing aid, changing staff
CNS triggersstroke, SDH
endocrine triggershyperparathyroidism, thyroid
metabolic triggersvitb12 deficiency, hepatic encephalopathy
memorize

Section 4

Question Answer
HX red flagspee + poo/ booze +drugs withdrawal / insulin (HYPO)
Hx must never forgetdrug and alcohol history
investigation for delirium history-collateral history-screening-bloods-imaging-urine dip
screening tools CAM or 4AT
CAM confusion assessment method 1.acute fluctuating course 2.inattention 3.disorganised speech 3.altered LOC
how to test inattention 20-1 test
4AT1.alertness 2.AMT4 3.attention (months of year backwards) 4.acute or fluctating change over last 2 weeks
components of AMT4abbreviated mental state test 1.age 2.DOB 3.place (current location) 4.year0
exminations must never forgetPRE and glucose
memorize

Section 5

Question Answer
Management delirium address trigger/preciptant factor + regular orientation on the ward + avoid
Monitoring should always startstart fluid chart, bowels diary, avoid bright lights and noises
CIantipsychotics (esp in PD/Lewy body dementia)
memorize

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