Delerium
Acute confusional state
Causes
- Brain
- Trauma
- Medications: opiates, sedatives, anticholinergics
- Infection
- Sepsis
- Cardio-Respiratory
- Hypoxaemia
- Hypotension
- Metabolic
- BM
- Hyponatraemia / hypernatraemia
- Dehydration / overload
- Urinary
- Urine retention
- GI
- Constipation
Management
- Reassure
- Familiar surroundings
- History
- Examination
- Investigations
- ABG
- BM
- FBC
- LFTs
- Electrolytes
- Sepsis screen - cultures, wound swab, urine dip, stool culture, sputum culture
- CXR
- ECG
Sedation
- Anxiolytic
- Analgesic
- Amnesic
- Hypnotic
Drugs
- Benzodiazepines: diazepam, midazolam
- IV anaesthetics: propofol, ketamine
- Inhaled agents: NO
- Opiates: morphine, pethidine, fentanyl
- Trichoroethanol - Chloral hydrate
- Butyrophenones - Haloperidol
- Phenothiazines
Determining level of sedation
Ramsay scoring system - ideal sedated patient is level 2-4
- Anxious/agitated
- Co-operative, tranquil
- Responds to commands only
- Asleep; brisk response to glabellar tap/stimulus
- Asleep; sluggish response
- Asleep; no response