So what is the differential diagnosis for delirium?
You're gonna think about whether or not somebody has another cognitive disorder happening
such as dementia. You're gonna wonder if they have a fluent aphasia
or a Wernicke's encephalopathy, if they have maybe an acute amnestic disorder,
psychosis, depression, malingering, also maybe a brain injury like a trauma to the head,
a subdural or subarachnoid hematoma, they might have an active bleed happening,
or structural abnormality. They maybe postoperative or be intoxicated or withdrawing from a substance.
And how would you treat delirium?
Well, you wanna first of all rule out any life threatening causes and then treat that.
Treat reversible causes, things like thyroid disorder or electrolyte imbalances,
urinary tract infections, or any other infective process.
You also want to think about using antipsychotics as a first line medication
in your agitated patient, so safety of the patient is very important
and somebody who's riding around in bed, and pulling out IV lines is not very safe
in the acute period so you might give them a low dose of quetiapine or haloperidol.
If you are administering an antipsychotic via an IV drip
which is something that you may opt to do in an intensive care unit,
you want to be very careful to also hook your patient up to telemetry monitoring.
So this way you can monitor them for any heart arrhythmias or cardiac problems
which can sometimes result from antipsychotic treatment.
You want to avoid benzodiazepines in a delirious patient,
so remember delirious patients have a waxing and waning sensorium.
They're very disinhibited and so you don't want to give them something else
that's gonna further inhibit and depress their CNS symptoms
because that can lead to more disinhibition, it can lead to respiratory depression,
it can increase the patient's risk for falling, so it can be very dangerous.
You also wanna give them one to one nursing staff.
So this is again a measure to enhance the safety of your patient
and you want to frequently reorient and redirect your patient.
So when you walk into the room, introduce yourself even if you are doing it over and over again.
Also, when you introduce yourself, tell the patient what day it is and what time of day,
explain why you're there. Encourage your patient to avoid napping,
keep the lights on during the day and the shades pulled shut at night
so this keeps your patient's circadian rhythm or sleep cycle in a good balance.
And always write on your orders no matter what medication you're prescribing,
write hold for sedation because you don't want overly sedate your already delirious patient.