Delicious delirium

The screaming patient on a very empty cabrio stroke unit – he stripped himself of all monitoring equipment, infusion. Obviously, his hemiplegia is also much better.

You can judge the importance of the topic from the fact, that this is the second time in a year we take it up. This is by request by one of our blog followers, so I want to use the opportunity to encourage anyone (both readers in particular :-)) to enlist suggestions for future talks.

The problem with delirium is that you should spend more time in recognizing the beginning and preventing it than you should thinking about therapy. Still, that doesn’t help at 2 am when your average 84 yo nursing home resident starts beating up your stroke nurse and you have to react. So we try to cover the basics in a rush as in this overview and then concentrate on hardcore psychopharmacology – how do you apply which substance in what patient?

I recommend distinguishing the following categories:

  • Blue alert – emergency self defense: a violent dangerous patient
  • Red alert – preventing major harm – an agitated hyperactive patient who could harm himself (or has already) by falling out of bed or pulling tubes
  • Yellow alert: infectious delirium – a restless patient who screams on your ward the whole night (this tends to turn other patient delirious)
  • Disturbed sleep rhythm with sundowning
  • Quite coherent, but hallucinating
  • Impeding delirium: slightly confused

As for references, there are recent reviews, even free and by a respectable Neurologist, but I can’t really recommend anything except uptodate. And of course the last blog entry on delirium.

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