Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Delirium

No description
by

Andrea Weber

on 4 September 2013

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Delirium

Acute Brain Injury
Global cognitive impairment
Perceptual disturbance
Change in psychomotor activity
Disordered sleep-wake cycle
Fluctuation
Features of Delirium:
Acute/Subacute
Inciting event
Hypo,hyper,mixed
Sleep-wake cycle
Fluctuating
Reversible...?
Delirium vs Dementia
Chronic (6 mths)
Insidious
Intact consciousness
Not delirium or other psychiatric disease
Delirium Dementia
40% of delirium cases develop some form of chronic brain syndrome
>3 of 4 ICU survivors with delirium leave ICU with long-term cognitive impairment that equates to mild/moderate dementia.
Premorbid state
How?
Dementia
Traumatic brain injury
Any cognitive dysfunction
Insult
E
lectrolyte imbalance
N
eurological
D
eficiencies (nutritional)

A
ge
C
NS depressant withdrawal
U
ncontrolled use (intox)
T
rauma
E
ndocrine disturbance

B
ehavioral-Psychiatric
R
x (medications)
A
nemia/Anoxia
I
nfectious
N
oxious stimuli (Ouch!)

F
ailure (organ)
A
pache score
I
mpairment (eyes/ears)
L
ight, sleep, circadian
U
remia (metabolic)
R
estraints
E
mergence delirium
...like what?
Age >75
40% demented in hospital become delirious

Decreased ACh producing cell volume
Decrease cerebral oxidative metabolism
> 5 medications
Psychoactive agents
Anticholinergic effects
Shock, hypoperfusion, hypotension:
Severe illness + decrease supply + increased demand
Ion gradients fail
Cortical spreading depression
Abnormal NT synthesis
Failure to eliminate neurotoxic by-products
Probability of transitioning to delirium increases linearly from 45% to 68% between scores of 10 and 18.
Melatonin
disturbance interferes with:
antioxidant activity
anti
-
inflammatory activity
analgesic
learning/memory
inhibits aggregation of amyloid into microaggregates/tangles
Neurotransmitter Hypothesis:
Low ACh
High DA, NE, GLU
High & Low 5HT, H1-2, GABA
Treatment
Accurate diagnosis
Treatment of underlying medical problems
Rebalance neurotransmitter derangement
Non-Pharmacological Interventions:
Continuity
Assess delirium risk factors within 24 hours
Multidisciplinary team
Orientation
Prevent dehydration/constipation
Avoid hypoxemia
Avoid infection
Encourage ambulation
Assess/treat pain
Avoid polypharmacy
Nutrition
Aid sensory impairment
SLEEP
Pharmacological Interventions:
Alpha-2 agonists (dexmedetomidine, clonidine)
3% vs 50% propofal vs 50% midazolam
Anti-psychotics (haloperidol, risperidone, quetiapine)
Melatonin
Serotonin receptor antagonist (Zofran)
Anti-glutamate agents (Valproate)
Dopamine agonists (HYPO active)
ACh-esterase inhibitor (rivastigmine)
Full transcript