When I was a consultation-liaison psychiatrist I taught trainees in different ways. One of them was what I called the Dirty Dozen slide sets. They were on various basic topics that are important for psychistrists to know. I tried to put the most important points on only a dozen powerpoint slides.
After I started blogging about C-L Psychiatry around 13 years ago, the WordPress blogging platform started offering a way to post slide presentations using what is called shortcode. Presumably, you didn’t really have to know anything about coding language but the instructions weren’t very helpful.
I think I started trying to make slides using shortcode shortly after it was first introduced around 2013. I had to contact WordPress support because I couldn’t learn shortcode. A lot of bloggers had the same problem.
I think my main reason for getting interested in shortcode was so I could cut down on how many powerpoint slides I had to convert to images, which can take up a lot of space on a blog site after a while.
Anyway, in the past few days I tried to pick up the shortcode but couldn’t get the hang of it again. I finally found a WordPress help forum in which I found a blogger’s solution. She made it so clear.
Anyway, the Dirty Dozen on Delirium is below. A few pointers: click in the lower right hand corner of the slide if you want to view the slides full size. Use the directional arrows on your keyboard to click through the slides. You can also just use the arrow handles on the slides if you don’t want to see them full size. . When you click the URLs on the delirium websites, right click and open them in a new tab.
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Dirty Dozen on Delirium by Jim Amos, MD
-What is Delirium?
-Acute brain injury, by definition a medical emergency; mimics many primary psychiatric disorders: affect, behavior, and cognition typically fluctuate
-Systems causes: multiple room changes, absence of clock and calendar, sensory aids, family members, use of physical & chemical restraints
What is Delirium, cont.
-Hospital cultural reasons: assumption delirium is: primary psychiatric problem per se and that it’s the duty of mainly one medical subspecialty (Psychiatry) to manage; nursing management problem; unavoidable consequence of severe medical illness
-Clinical Features of Delirium
-Disorders of consciousness: hyperalert to obtunded
-Disorder of affect, behavior, cognition
-Disorder of perception: hallucinations, often visual
-Predisposing Risk Factors
-Age 65 or older
-Cognitive impairment
-Severe illness
-Dehydration
-Precipitating risk factors
->3 new medications added
-Urinary catheter
-Any iatrogenic event
-Physical restraints
-Malnutrition
-Delirium Prevalence & Outcome
-20% prevalence in general hospital
-Range up to 80% prevalence in ICU
-Outcomes
-Increases length of stay, admit to long term care, mortality
-Post-discharge decline in ADLs & cognitive function
-Etiology
-Underlying medical cause(s)
-General medical conditions
-Medications
-Substance intoxication and withdrawal
-Delirium Screening (one example)
-The Confusion Assessment Method (CAM) developed by S.K. Inouye, rated in
around 5 minutes
-Acute change in mental status/fluctuating course and inattention; either disorganized thinking or altered level of consciousness
-Preventing Delirium
-Frequent reorientation
-Encourage normal sleep-wake cycle
-Encourage mobility
-eyeglasses, hearing aid available
-avoid anticholinergic, sedative-hypnotic drugs
-prevent organic drivers: hypoxia, infection
-Treatment of Delirium
-First treat underlying medical causes
-Avoid benzodiazepines unless alcohol withdrawal is the cause
-Avoid other drugs that cause delirium
Go Retire Psychiatrist 