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Delirium, Emergency Medicine

Lori A. Stolz and Arthur B. Sanders Reviewed 06/2017
 


Basics

Description

  • Delirium is a clinical syndrome characterized by acute changes in awareness, cognition, and perception with a waxing and waning course.

  • Delirium is a syndrome secondary to an underlyi...

Diagnosis

Signs and Symptoms

  • Disturbed consciousness:

    • Hyperalert:

      • Combative

      • Agitation

    • Hypoactive:

      • Lethargic

      • Stupor

      • Coma

    • Can have mixed hyperalert and hypoactive state with rapid oscillations

  • Cognitive changes:

    • D...

Treatment

Pre-Hospital

  • IV access:

    • Pulse oximetry to monitor respiratory status:

      • Glucose measurement

      • ECG monitoring

  • Naloxone if associated respiratory insufficiency

  • Monitor patient:

    • Advanced life support (ALS...

Follow-Up

Disposition

Admission Criteria

  • When cause is unclear, admit.

  • If delirium has not resolved, admit.

Discharge Criteria

Patient could be discharged if: 
  • Treatable cause is found and treated

  • Mental sta...

Pearls and Pitfalls

  • Identify underlying cause

  • Delirium is often missed by emergency physicians and maintaining an awareness of delirium as a syndrome is critical.

Additional Reading

  • Han  JH, Zimmerman  EE, Cutler  N, et al. Delirium in older emergency department patients: Recognition, risk factors, and psychomotor subtypes. Acad Emerg Med.  2009;16:193–200...

Codes

ICD9

  • 291.0 Alcohol withdrawal delirium

  • 293.0 Delirium due to conditions classified elsewhere

  • 780.09 Other alteration of consciousness

  • 292.81 Drug-induced delirium

  • 290.11 Presenile dementia with delir...

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