Monday February 27, 2006
Delirium is one of the most hidden and deadly enemy in ICU. It increases mortality, it cost money and its hard to recognise. In this regard an organised effort is underway in the form of website charged by Dr. E.Wesley Ely of Vanderbilt University Medical Center.
It contains numerous tools and information for Critical Care staff, particularly this slide show (Dr. Ely) is worth browsing.
Just to have a flavor, see this simple mnemonics from the site.
D Drugs, Drugs, Drugs
E Eyes, ears 1
L Low 02 (MI, ARDS, PE, CHF, COPD)2
R Retention (of urine or stool), Restraints
(S) Subdural, Sleep deprivation
1 Poor vision and hearing are considered more risk factors than true causes, but should be "fixed" or improved if possible. Cerumen is common cause of hearing impairment.
2 "Low 02 states" does NOT necessarily mean hypoxia, rather it is a reminder that patients with a hypoxic insult (e.g. Ml, stroke, PE) may present with mental status changes with or without other typical symptoms/signs of these diagnoses.