Delirium Part 2 Evaluation Management - …：谵妄2部分评价与管理—….ppt

CHAMPDelirium Part 2:Evaluation Management Andrea Bial, M.D. University of Chicago Goals Develop a plan for teaching a Systematic Approach to the Evaluation of hospitalized older patient with delirium. Develop a plan for teaching an appropriate Treatment Plan for the hospitalized older patient with delirium Overnight Events:  Morning Rounds at the Bedside 75yo W admit 2d ago w/ COPD, bronchitis Intern reports: o/n she pulled out her IV, thought she was at home X-cover ordered Prosom 1mg po abx Overnight, cont’d Currently, pt w/o c/o. Doesn’t recall events of previous night. PE: sleepy, arouseable 37.6 148/62 88 20 93%2L Lungs w/ faint wheeze bilat Rest w/o change Labs WBC 13.2, diff P; H/H stable Na 133, BUN 26, Cr 1.2 Overnight, cont’d A/P #1) COPD—cont nebs, steroids, po abx #2) HTN—stable on meds #3) Confusion—add risperdal 1mg QHS prn #4) Disp—await PT/OT Systematic Approach to the Evaluation of Delirium No one “gold standard” approach Multiple Mnemonics (e.g., Delirium) algorithms Need individualized, systematic approach to avoid missing potential causes Few studies exist specifically looking at causes Evaluation of Delirium: Causes Francis (1990) Large teaching hospital General medicine patients (n=229) Delirium developed in 22% (n=50) Determined cause(s) as: definite, probable, or possible 18 (36%) w/ one definite cause (Drug toxicity, then infection=fluid/lyte imbalance) 10 (20%) w/ one probable cause 22 (44%) w/ 1 cause; 62 possible etiologies (2.8/pt) Evaluation: Dementia Teaching Points Hx of dementia? Hx of sundowning? Agitated dementia ≠ delirium 4. Importance of considering dx: DEMENTIA DELIRIUM Evaluation: Physical Exam Head to toe: Vitals (temp, HR, RR, BP, pulse ox, pain) Head (CVA, bleed, meningitis, sz, blind, deaf) Lung (pneumonia, PE, CHF) Chest (ischemia, CHF, arrhythmia) Abd (ischemia, impaction, bleed) GU (UTI, retention) Extrem (pain, volume stat