Lightning Learning: Delirium
““Delirium is greatly under-detected in the ED. 1/3 of cases are preventable and twice as likely to die than non-delirious patients.””
What?
Disturbance in:
Attention
Level of arousal and/or mental status including unusual drowsiness
It has an acute onset and fluctuating course.
Psychosis (hallucinations and delusions) occurs in 30-50%.
There may or may not be clear precipitants on review of the history, physical and laboratory findings.
Why?
Delirium is greatly under-detected in the ED and 1/3 of cases are preventable.
Delirious patients are twice as likely to die than non-delirious patients.
Delirium in older patients is associated with 8x risk of future dementia.
Delirium is associated with increased length of hospital admission and decreased future independence.
Patients with dementia are more likely to develop delirium when admitted to hospital.
How?
Participate in simulation. Do the basics early and well. Alongside an infection screen, check for other causes:
Urinary retention
Constipation
Uncontrolled pain
There may be multiple precipitants.
Further Reading
- #EM3 via RCEMFOAMed: Acute Confusion In ED (podcast)
