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Do u deal w delirium? Are you a hospitalist abt to call geri consult?
Here's #tweetorial FAQs on delirium!
We'll show u what u can do b4 calling geri/psych consults, or help u manage delirium on ur own if you lack access to consultants!
#medtwitter #FOAmed #medstudenttwitter
Here's #tweetorial FAQs on delirium!
We'll show u what u can do b4 calling geri/psych consults, or help u manage delirium on ur own if you lack access to consultants!
#medtwitter #FOAmed #medstudenttwitter
FAQ1: In delirious pts w/ QTC>500 w/ severe agitation causing harm to self+others, what would you use?
FAQ1: consider ativan
Restraint has no therapeutic properties. It's traumatic to pt+family&can cause serious injuries, esp in fall pts w/ fractures
Ativan is lesser of 2 evils - it has anti-anxiety property&can be therapeutic since many delirious pts are also anxious
Restraint has no therapeutic properties. It's traumatic to pt+family&can cause serious injuries, esp in fall pts w/ fractures
Ativan is lesser of 2 evils - it has anti-anxiety property&can be therapeutic since many delirious pts are also anxious
FAQ2: Pt is AAOx3 but still confused - is it delirium?
To figure this out, we need to look at our diagnostic tool. In the US, CAM by @sharon_inouye is widely used
First, let's look at the components of CAM
Remember: u need (1&2) + (3 or 4)
To figure this out, we need to look at our diagnostic tool. In the US, CAM by @sharon_inouye is widely used
First, let's look at the components of CAM
Remember: u need (1&2) + (3 or 4)
FAQ2: Since "disorganized thinking" (AAOx3) is not a required component, patient who's AAOx3 CAN still be delirious if there's:
acute change
inattention
altered consciousness
acute changeinattentionaltered consciousness
Pro-tip:To dx delirium, no need to ask all Qs for AAOx3
Use UBCAM&save time
All you need are 2Qs
Months of the year backwards - do this 1st, if 
, you've ruled out delirium
Day of the week for "disorganized thinking"
Determine acute change/consciousness from HPI/PE
Use UBCAM
&save timeAll you need are 2Qs
Months of the year backwards - do this 1st, if , you've ruled out deliriumDay of the week for "disorganized thinking"Determine acute change/consciousness from HPI/PE
FAQ3: Pt w ?baseline dementia, is confusion 2/2 delirium or dementia?
Unless CAM-, hard to tell
If CAM-
dementia/BPSD
If CAM+delirium+/-dementia
So what now?
Nonpharm is 1st line/more effective for both! try this b4 calling consult since this question might not change mgt!
Unless CAM-, hard to tell
If CAM-
dementia/BPSDIf CAM+
delirium+/-dementiaSo what now?
Nonpharm is 1st line/more effective for both! try this b4 calling consult since this question might not change mgt!
Pro tip #1: don't do cognitive testing (MoCA/MMSE) during delirium
These are screenings for dementia - so not only do they not change mgt, but they'll also be inaccurate
i.e. I'd do poorly if I'm sick in ICU/delirious although I'm an MD w/ no dementia at baseline (or so I say)
These are screenings for dementia - so not only do they not change mgt, but they'll also be inaccurate
i.e. I'd do poorly if I'm sick in ICU/delirious although I'm an MD w/ no dementia at baseline (or so I say)
Pro tip #2: for agitation in dementia (BPSD), what do you use as first line agent?
This systematic review has a nice BPSD/agitation in dementia algorithmFirst line is...Risperidone!
Ranked high on efficacyRanked high for time to onsetBacked by multiple large RCTs Approved in UK/CAIt's not always seroquel/quetiapine!
https://bit.ly/3cZEUiv
FAQ4: I fixed all reversible causes of delirium but pt isnt better, what's going on?
Remember: the brain takes time to heal, delirium can last for months!
So don't be discouraged if pt doesn't get better right away. Just make sure u didn't miss ANY reversible cause
Remember: the brain takes time to heal, delirium can last for months!
So don't be discouraged if pt doesn't get better right away. Just make sure u didn't miss ANY reversible cause
Pro tip: knowing this abt delirium prognosis, *gold star* if u counsel family what to expect from the get-go
We rarely let family know that pt can remain delirious for months after discharge, and many family members keep wondering why pt isn't better - it's not a good feeling!
We rarely let family know that pt can remain delirious for months after discharge, and many family members keep wondering why pt isn't better - it's not a good feeling!
SUMMARY:
Avoid restraints, don't be afraid of ativan
AAOx3 does NOT rule out delirium
Whether delirium or dementia, try nonpharm 1st
Seroquel is NOT 1st line
Counsel family re: delirium may last months
2Qs: months backwards+day of the week
Avoid restraints, don't be afraid of ativanAAOx3 does NOT rule out deliriumWhether delirium or dementia, try nonpharm 1stSeroquel is NOT 1st lineCounsel family re: delirium may last months2Qs: months backwards+day of the week
Delirium is one of the most catastrophic, traumatic, difficult to treat conditions BUT if you understand diagnosis+prevention, you've already won half the battle
If you have tips/pearls, please add more below! Let's help each other get better at dealing w/ this horrible disease!
If you have tips/pearls, please add more below! Let's help each other get better at dealing w/ this horrible disease!
