Today, I reviewed and link to The Internet Book Of Critical Care Chapter [TOC], Delirium, October 11, 2021 by Dr. Josh Farkas.
Here are the links to the above resource.
Pitfalls
- DO NOT treat agitated delirium with a benzodiazepine. This will suppress symptoms temporarily, but will eventually make the delirium worse.
- Avoid benzodiazepines in general, with certain very specific exceptions (chronic benzodiazepine use, status epilepticus). The practice of using lorazepam for insomnia needs to be abolished.
- Don’t overlook the cause of delirium, especially when it represents a dramatic neurologic change in a patient without any neurologic history. It may be the manifestation of a severe disease process (e.g. subdural hematoma, sepsis).
- Don’t treat elderly, multimorbid ICU patients with the same doses of antipsychotic that you would use for a young psychotic patient. When feasible, start low and titrate to effect.
CONTENTS
- Rapid Reference
- Definition & diagnosis
- Delirium mimics
- Causes
- Evaluation
- Delirium prevention
- Treatment
- Podcast
- Questions & discussion
- Pitfalls
Going further:
- Delirium
- Delirium (Chris Nickson, LITFL)
- Management of pain, agitation and delirium in the ICU (Dan Herr, Maryland CC project)
- Antipsychotics
- MINDS-USA & role of antipsychotics in delirium (PulmCrit)
- Allergies to haloperidol don’t exist.
- Olanzapine is ok for IV administration. And doubling down on IV olanzapine again here.
- Other sub-typics
- Re-engineered analgesic ladder for critical care.
- Exploration of the evil of fentanyl infusions.
- Sleep-protective monitoring.
CONTENTS