Delirium
Agitation, hallucinations, and other behaviour changes are common in the final days of dying – caused by the disease, the treatment, dehydration, and the combination of anticholinergics, steroids, sedatives and opioids being used for palliation. This agitation is disturbing to the patient and caregivers and is a common reason for presentation to ED. Easily reversible causes may include fecal impaction, urinary retention, and dehydration.
Symptomatic treatment will be escalating doses of:
- Haloperidol
- Lorazepam or Midazolam
- Atypical antipsychotics (e.g. Risperidone, Quetiapine, or Olanzapine)
- Methotrimeprazine (©Nozinan)
Don’t forget about your non-pharmacologic treatments of delirium including: enhancing orientation; implementing measures to promote sleep; having familiar objects such as family photographs at bedside, etc. For more information on Delirium visit the section in this website on Cognitive Impairment in geriatric emergency medicine.
Discussion: Delirium
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lorazipam
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lorazepam
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yes
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will keep it in mind
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Ok.
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good
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important info
haldol
haldol
Haldol and ativan
clonazepam and citalopram
•Haloperidol
•Lorazepam
•Methotrimeprazine (©Nozinan)
helpful
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Cognitive Impairment module discourages the use of benzos (unless e.g. alcohol withdrawal) but here it is recommended again…
Confusing once again …
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We have palliative care orders at our facility that are complaint driven and are very useful. They save a lot of phone calls and time lost in care delivery.
Haldol…great drug.
Yes share
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No additional comments
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Haloperidol
haloperidol its the first option
Haloperidol
Haloperidol
Haloperidol
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versed
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Documentation of CAM would also be helpful
have used both haldol and nozinan with effect, in the LTC setting for uncontrolled nausea and agitation
I think a CAM should be done to establish the diagnosis of delirium
we are drawing up a draft proposal at our hospital for palliative sedation therapy which addresses dyspnea, delirium,pain,seizures and any other intractable symptoms. Versed is first followed by nozinan and phenobarb
Would you be interested in sharing your pre-printed order set so that we could add it to the Related Resources page?