The Confused Patient

Question 1

Causes of delirium: PINCH ME

Answer 1

Pain
Infection
Nutrition/metabolic
Constipation/retention
Hydration
Medication
Environment

Question 2

Delirium screen

Answer 2

Bedside

• ECG
• Urine dip + MSU

Bloods

• FBC, CRP, U+E, LFT, Ca, Glu, TFT, B12, Folate
• Septic screen if needed (inc. cultures)

Imaging.
- CXR, ?AXR, CT head, USS abdo

Special tests.

• wound swabs, c.diff antigen, other
• EEG

Question 3

Delirium management: non-pharm

Answer 3

• Calm approach
• Well-lit area
• Continuity in nursing /medical staff
• Orientation (clocks)
• Access to call bell/toilet
• Remove unnecessary lines, investigations, etc.
• Photos of family, etc.
• Eating/drinking
• Radio/tv
• Verbal de-escalation (CROMA etc)

Question 4

Delirium management: pharm

a) Drug choice
b) Administration
c) Other considerations

Answer 4

a) Haloperidol (beware in PD)
Lorazepam

b) - PO or IM/IV
- START LOW and GO SLOW

c) - Mental capacity assessment
- DOLS
- Interactions, eg. other sedating medications

Question 5

Verbal de-escalation: DEFUSE

Answer 5

• Decide if appropriate for verbal de-escalation
• Ensure safety - security backup, etc.
• Form relationships
• Utilise interests
• Set limits
• Enforce/evaluate