Delirium

Delirium

This is more florid than ACS. It also manifests typically with disorientation, confusion, and reduced attention but, in addition, the patient is often frightened, irritable, and more profoundly disorientated. The patient may have frightening hallucinations and/or delusions, and exhibit aggressive behaviour.

Causes: Most common causes will vary with age. Systemic infection: check chest, urinary tract, surgical wounds, IV cannula sites, CSF. Chronic subdural haematoma may present with ACS.

What is my Management? 

Treat cause if one can be recognized. At night, turn the lights on to improve the patient's orientation. Give 50 ml of 50% dextrose IV if hypoglycaemia is suspected. Treat disturbed behaviour with chlorpromazine 25 to 50 mg IM/PO q6h or haloperidol 1.5 to 3 mg PO tds initially or 2 to 10 mg IM, repeated as necessary every 4 to 8 hours to a maximum daily dose of 18 mg. Avoid benzodiazepines.

Nursing is very important, Attempt to reassure the patient.