HELP! I Have Been Called to See Patient (CTSP) for Delirium!

It is essential to follow a structured and thorough approach when assessing delirium in patients to ensure a comprehensive evaluation and accurate diagnosis.

Utilize tools like the Confusion Assessment Method (CAM) or the 4 'A's Test (4AT) to evaluate the patient's mental status.

There are many other scales which may be less commonly used to screen for delirium, including: Delirium Rating Scale, Delirium Index, Delirium-O-Meter.

A detailed physical examination should be conducted to eliminate any possible underlying causes of delirium, including infections or medication side effects.

Assess the patient, review if there are any unmet needs. Eg. Assess if patient is constipated, any urinary retention etc.

Review the patient's medical history and medication list thoroughly, with a focus on identifying potential precipitating factors.

Medications that have been implicated in delirium:

• Beta blockers

• Anti histamines

• Benzodiazepines

• Opioids

• Baclofen

Ordering relevant laboratory tests, imaging studies (eg. CT brain), and collaborating with other healthcare professionals may be necessary.

Regular monitoring of the patient's condition is vital to observe any changes over time, aiding in tracking the progression or resolution of symptoms effectively.

Plan:

Assessment:

• Sleep and behaviour chart

• Post Void Residual Urine- to look for urinary retention

• Reorientation

• Reduce restraints

• Allow family to accompany patient (if possible)

Bloods and Investigations:

• Full blood count, electrolytes

• B12, folate, thyroid panel

• +/- infective markers, Chest XR, electrocardiogram

Choice of Medications:

• If pure delirium, consider haloperidol

• May consider low dose quetiapine if qtc not prolonged

• olanzapine comes in orodispersible forms

If in doubt, consult your senior on call!

Family updates:

Remember to update the family!