Delirium

Management & Disposition

Recognition

Delirium is poorly detected and documented in the ED.

Performance of routine assessment using 4 AT is a requirement for all patients aged ≥ 65years in our department

Seek & Treat

Identify and treat the underlying cause.

Aim to manage a patient with delirium as a matter of urgency. The ED environment can worsen and even precipitate an episode of delirium in those who are not delirious at initial presentation.

Prevention

Prevention of delirium is imperative. It is estimated that up to a third of cases are preventable.

• Consider supervision

• Ensure hearing aids and glasses are accessible

• Regular orientation

• Appropriate lighting for time of day, use of clocks

• Family visits with objects from home

• Regular analgesia if in pain

• Use of urinary catheters and IV medications only if necessary

• Prevent dehydration & constipation

Avoid Sedation

Avoid sedation unless patient represents a risk to themselves or others or is highly agitated or distressed. Every effort should be made to reassure and re-orientate the delirious patient and a family member should be encouraged to stay with them.

If sedation is absolutely necessary oral medication should be offered before parenteral medication if possible.

Always consider a patient’s age, weight, cardiac status, QT interval, heaptic and renal function prior to prescribing tranquilizers.

• An example of First line therapy is;

  • Haloperidol  0.5-1mg PO and/or Lorazepam 0.5 - 1mg PO

• If the patient is unwilling or unable to take PO the above medication can be given IM. Please consult your local prescribers guideline.

Disposition

The vast majority of patients with delirium will need to be admitted to hospital.

They should be flagged for admission early and be prioritised for an inpatient delirium friendly bed as prolonged stays in the loud, bright and chaotic environment of the ED can delay their recovery.