n_delirium
Table of Contents
delirium
see also:
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?
- the diagnosis of delirium generally requires a present and abnormal rating for criteria (1) AND (2) AND EITHER (3 or 4) of the CAM confusion assessment test for diagnosis of delirium
ED Mx of the elderly patient with delirium
exclude and treat potential time critical causes
- ensure there is no immediately manageable cause for acute confusion such as:
- pain such as from acute urinary retention
- iatrogenic from medication administration
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:
- FBE, U&E, LFT, CRP, Ca, PO4, TSH
- blood cultures if suspect sepsis / septicaemia
- 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: 2020/02/02 20:20 by 127.0.0.1