Summary Writer: Jeffrey Duncan
Script Writer: Jeffrey Duncan
Editor: Eve McClure
Interviewee: Scott Murray
James speaks with Dr Scott Murray, Geriatric Physician, about an issue that concerns all of us late at night or in the early mornings on the wards.
Scott Murray is a Director of Prevocational Education and Training and a Senior Staff Specialist in Geriatric Medicine at Royal Prince Alfred and Balmain Hospitals, Sydney. Scott 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 confusionalstate”, is a common clinical syndrome 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 afterhours. It is under-recognised with rates of approximately 20-30% in general medical wards, 50% on geriatric wards and in orthopaedic patients, can approach 85%. Hyperactive delirium manifesting as agitation, confusion and restlessness is often easy to recognise, whilst 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 signify the hallmarks of delirium, the CAM score is a rapid assessment tool for nursing and medical staff and may help distinguish delirium from other conditions such as depression, dementia and acute psychosis (1).
Case – 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.
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