James speaks with Dr Scott Murray about delirium. Delirium is an issue that concerns all of us late at night or in the early mornings on the wards.
Summary Writer: Jeffrey Duncan
Script Writer: Jeffrey Duncan
Editor: Eve McClure
Interviewee: Scott Murray
Dr Scott Murray is a Geriatric Physician. Scott is a Director of Prevocational Education and Training and a Senior Staff Specialist in Geriatric Medicine at Royal Prince Alfred and Balmain Hospitals, Sydney. He commenced Advanced Training at Royal Prince Alfred and Concord Hospitals before completing his FRACP at University College London and St. Pancras Hospitals in London. His special interests include acute care for older patients, continence, and JMO education.
With Dr Scott Murray, Geriatrician, Royal Prince Alfred Hospital, Sydney, Australia
Delirium, sometimes called “acute confusional state”, is a common clinical syndrome. It’s characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course. It usually develops over 1-2 days (1).
It is a common clinical problem and a challenge for junior doctors after hours. It is under-recognised with rates of approximately 20-30% in general medical wards, 50% on geriatric wards, and in orthopaedic patients it can approach 85%.
Hyperactive delirium manifesting as agitation, confusion and restlessness is often easy to recognise. On the other hand, hypoactive delirium manifesting as sedation, quietness and psychomotor retardation, is very easy to miss (2). Early intervention in hospitalised patients reduces the risk of delirium, the severity and the duration of symptoms. With inattention and fluctuation signifying the hallmarks of delirium, the CAM score is a rapid assessment tool for nursing and medical staff. The CAM score may help distinguish delirium from other conditions such as depression, dementia and acute psychosis (1).
You are a junior doctor working after hours covering the acute medical ward. You are called to see Joan, a 78-year-old female who was admitted three days prior with community-acquired pneumonia and has been worrying the nurses this evening. She is crying out, moaning and, whilst attempting to get out bed, had a fall. The nurses are requesting an assessment and the prescription of a tranquiliser to limit future activities.
If you enjoyed listening to this week’s podcast feel free to let us know what you think by posting your comments or suggestions in the comments box below.
If you want to listen to this episode while not connected to WiFi or the internet, you can download it. To find out more go to Apple support (https://support.apple.com/en-us/HT201859)