How I manage delirium by Dr Nudrat Rashid
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How I manage delirium by Dr Nudrat Rashid
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How I manage delirium by Dr Nudrat Rashid
- 1. HOW I MANAGE DELIRIUM Nudrat Rashid Intensivist @NudratRashid
- 2. NO CONFLICTS OF INTEREST
- 3. MANAGEMENT • Early recognition / Routine monitoring • Recognise and treat underlying cause • Treat pain and provide excellent supportive care. • Non pharmacological treatment • Pharmacological treatment
- 6. “A disturbance of consciousness with inattention accompanied by a change in cognition or perceptual disturbance that develops over a short period of time and fluctuates over time.” DEFINITION icmwk.com
- 7. TYPES • Hyperactive • Mixed • Hypoactive
- 8. INCIDENCE • 80% in ICU patients • 20-50% in HDU patients • 65-70% undiagnosed if unmonitored www.lacrisert.co m
- 11. EARLY RECOGNITION • Confusion Assessment Method for ICU (CAM-ICU) • Intensive Care Delirium Screening Checklist (ICDSC)
- 12. Ask family members “Is this a change?”
- 13. BIOMARKERS • S100B • Serum anticholinergic activity • Brain-derived neurotrophic factor • Neuron-specific enolase • Interleukins • Cortisol
- 14. DELIRIUM(S) CAUSES • D - Drugs, Dementia • E - Eyes & Ears (poor vision & hearing), Endocrine • L - Low O2 states (CHF,COPD,ARDS,MI,PE) • I - Infection • R - Retention (Urine & Stool) • I - Ictal states • U - Underhydration/Undernutrition • M - Metabolic upset • (S) - Sleep deprivation, Subdural
- 15. THE 5 P’S • PEE • POO • PUS • PAIN • POISON
- 16. LIFE THREATENING CAUSES WHIP X 2 • W - Wernicke’s, Withdrawal • H - Hypertensive encephalopathy, Hypoglycaemia, metabolic and endocrine • I - Infection, Intracranial disease • P - Poisons, Porphyria
- 18. NON PHARMACOLOGICAL • Frequent re-orientation of patients • Early mobilisation • Early removal of IDC’s and lines. • Day and night routine, improve sleep hygiene • Visual and hearing aids (wax removal) • Get the family involved
- 20. SUNSHINE THERAPY
- 24. PREVENTION BUNDLES ABCDEF • AB Awakening and breathing trials • C Choosing the right sedative(s) • D Delirium monitoring and management • E Early mobility and exercise • F Family communication and involvement
- 26. KEY POINTS • Delirium is very common and frequently missed. • Use a screening tool • Non pharmacological therapy should be encouraged. • Know your anti-psychotic. • Employ Prevention Bundles.