delirium cordis


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de·lir·i·um cor·'dis

obsolete term for atrial fibrillation.

delirium

(di-lir'e-um) [L. delirium, madness, insanity]
An acute, reversible state of disorientation and confusion. Delirium is marked by disorientation without drowsiness; hallucinations or delusions; difficulty in focusing attention; inability to rest or sleep; and emotional, physical, and autonomic overactivity.

Etiology

Common causes include drug and alcohol withdrawal; medication side effects; infections (esp. sepsis); pain; surgery or trauma; hypoxia; electrolyte and acid-base imbalances; sensory deprivation and sensory overload; dementia; hospitalization and/or depression, esp. but not exclusively in people 65 years or older.

Treatment

Treatment involves determining the cause of the delirium and removing or resolving it if possible.

Patient care

Preventive measures may sometimes reduce the risk of delirium in hospitalized patients. Such measures include providing glasses and hearing aids to patients with known sensory defects; mobilizing patients or providing range-of-motion (R.O.M) activities several times each day; avoiding multiple new medications; maintaining hydration by encouraging oral fluid intake; using holistic measures to promote relaxation; inducing sleep and reducing anxiety; and engaging family members or people familiar to delirious patients in their care.

The health care professional should consider delirium whenever an acute change in mental status occurs. Supportive care consists of minimizing unanticipated, frightening, or invasive procedures; integrating orienting statements into normal conversation; and providing confused patients with a calm supportive presence. When patients express deluded thoughts, it is important not to try to convince them that their perceptions are distorted. Speaking in a calm, clear voice, talking directly to the patient and using only simple statements and questions, and maintaining eye contact may be helpful. Maintaining caregiver consistency and encouraging family visiting are especially beneficial. Delirious patients should be roomed close to nursing stations so that they can be frequently observed. Physical protection from self-injury should be provided by bed alarms, wander guards, or mattresses placed on the floor to decrease the likelihood of patients' falling. Delirious patients should be permitted to sleep without interruption. Pain that they experience should be treated with analgesic drugs that do not affect mental status. Large calendars and clocks should be provided to aid orientation. Natural light should be used to delineate day and night. Other useful preventive interventions include limiting interfacility transfers and room changes as much as possible and providing complementary therapies to decrease agitation and aggression (e.g., music therapy, massage, and shared activities). Antipsychotic drugs and benzodiazepines may be used cautiously when other nonpharmacological interventions have failed.

acute delirium

Delirium that develops suddenly.

alcoholic delirium

Delirium tremens.

delirium cordis

Atrial fibrillation.

emergence delirium

Unusually intense agitation in a patient awakening from anesthesia.

febrile delirium

Delirium occurring with fever.

delirium of negation

Delirium in which the patient thinks body parts are missing.

delirium of persecution

Delirium in which the patient feels persecuted by those around him.

partial delirium

Delirium acting on only a portion of the mental faculties, causing only some of the patient's actions to be unreasonable.

senile delirium

An intermittent or permanent state of disorientation, hallucination, confusion, and wandering that may come on abruptly in old age or may be associated with senile dementia.

toxic delirium

Delirium resulting from exposure to or ingestion of a psychically active agent, e.g., jimson weed, LSD, mescaline, or psilocybin.

traumatic delirium

Delirium following injury or shock.

delirium tremens

Abbreviation: DT
The most severe expression of alcohol withdrawal syndrome, marked by visual, auditory, or tactile hallucinations, extreme disorientation, restlessness, and hyperactivity of the autonomic nervous system (evidenced by such findings as pupillary dilation, fever, tachycardia, hypertension, and profuse sweating). About 15% of affected patients may die, usually as a result of comorbid illnesses. In most affected patients, recovery occurs within 3 to 5 days. Synonym: alcoholic delirium See: alcoholism; alcohol withdrawal syndrome

Treatment

Sedation with benzodiazepines is the chief therapy. Other supportive care includes airway protection (and intubation when indicated); fluid and electrolyte resuscitation; hemodynamic support; protection of the patient from injury; and precautions against seizure. Comorbid conditions resulting from chronic alcoholism (e.g., pancreatitis, esophagitis, hepatitis, or malnutrition) may complicate therapy.

Patient care

The patient and those nearby need to be protected from harm while prescribed treatment is carried out to relieve withdrawal symptoms. The patient's mental status, cardiopulmonary and hepatic functions, and vital signs (including body temperature) are monitored in anticipation of complicating hyperthermia or circulatory collapse. Prescribed drug and fluid therapy, titrated to the patient's symptoms and blood pressure response, are administered as prescribed, or by symptom-triggered algorithms. A calm, evenly illuminated environment is provided to reduce visual hallucinations. The patient is addressed by name; surroundings are validated frequently to orient the patient to reality, and all procedures are explained. The patient is observed closely and left alone as little as possible. Physical restraints should be reserved for patients who are combative or who have attempted to injure themselves. Patience, tact, understanding, and support are imperative throughout the acute withdrawal period. Once the acute withdrawal has subsided, the patient is advised of the need for further treatment and supportive counseling.

CAUTION!

It is crucial to distinguish the signs and symptoms of alcoholic delirium from those caused by intracerebral hemorrhage, meningitis, or intoxication with substances other than alcohol. Evaluation of the patient suspected of having the DTs may therefore require neuroimaging, lumbar puncture, or drug screening.