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Delirium (Detection/Diagnosis (4AT, Alertness: Normal = 0, Mild sleepiness…
Delirium
Detection/Diagnosis
4AT
Alertness: Normal = 0, Mild sleepiness <10 sec after wakening = 0, Clearly abnormal 4
AMT: age, DOB, place, year. 1 mistake = 1 point, 2 mistakes= 2 points
Attention: Recite months in reverse order. 7 or more correct = 0, < 7 correct = 1 point, Untestable or cannot participate = 2 points.
Acute change or fluctuating alertness: No = 0 points, Yes = 4 points
SCORE > 4 possible delirium +/- COGNITIVE IMPAIRMENT. Implement TIME. Score 1-3 possible COGNITIVE IMPAIRMENT. Score 0 Delirium/severe cognitive impairment unlikely
TIME (Triggers, Investigate, Manage, Engage)
TRIGGERS: Pain, constipation, urinary retention, dehydration, drugs, BM, alcohol/drug abuse, sensory impairment, immobility?
INVESTIGATE: NEWS, screen for infection, bloods, ECG, imaging
MANAGE: Document Dx of delirium, potential causes and treatment plan.
ENGAGE AND EXPLORE: If appropriate; explain to Pt and family Dx of delirium. Doe Pt have capacity to consent? If not complete AWI
Causes
Definition
Delirium is a clinical syndrome characterised by disturbed consciousness, cognitive
function or perception, which usually has an acute onset and fluctuating course
Signs & symptoms
Delirium can be hypoactive (withdrawn, quiet and sleepy), hyperactive (too alert, agitated
and often paranoid) or mixed. Hypoactive and mixed delirium can be more difficult to
recognize
confusion, hallucinations, sleepiness, restlessness, withdrawal or change in personality
Treatment: Initial management of symptoms should be aimed at causative and contributory
factors
Use person centred approach and utilize family and Getting To Know Me document
If despite these measures there is severe distress or risk to the person or others
drug treatment may be used
First line treatment if no contraindications is
• Haloperidol 0.5-1mg PO (max 2 mg/24 hours) or if oral not possible
• Haloperidol 0.5mg IM (max 2 mg/24 hours)
See Drugs and Therapeutics handbook for details