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n_delirium

delirium

introduction

  • delirium is common in elderly hospital inpatients and is associated with increased morbidity and mortality
  • early recognition, investigation and management with appropriate inpatient team care is essential to good outcomes by minimising functional and cognitive decline, pressure ulcers and preventing falls.
  • it should be differentiated from a primary psychiatric diagnosis such as a psychosis, or from drug or alcohol related withdrawal states.

is it delirium?

ED Mx of the elderly patient with delirium

exclude and treat potential time critical causes

assess cognitive state

investigations

  • standard minimal investigations generally include:
    • radiology based on clinical indications:
      • CXR to exclude pneumonia
      • consider AXR to exclude bowel obstruction or sigmoid volvulus
      • CT brain (non-contrast) if focal neurology, history of a fall, or on anticoagulants
      • CT brain with contrast if PH of a neoplasia / cancer / tumours
    • lab tests:
    • ECG
    • FWT urine and if positive for nitrites or leuks then send for MSU m/c/s and consider commencing IV antibiotics for presumed urosepsis

general ED care

  • pillow under legs to keep heels from contact
  • avoid routine IDC insertion
  • bladder scan after each void + minimum once per nursing shift to detect acute urinary retention and Mx accordingly (eg. consider in/out catheter but if needed more than twice then insert IDC)
  • early referral to Aged Care inpatient team if aged > 65 years or with known dementia and not likely to be a primary psychiatric diagnosis (otherwise refer to Aged Persons Mental Health Unit)

ED Mx of behavioural disturbance and aggression

n_delirium.txt · Last modified: 2018/03/19 23:38 by wh