Mónica De Sousa

"The ICU nurses played recordings of my voice for my dad. My actual voice. Telling him who I was, where he was, that we loved him. They said it calmed him when nothing else worked." - Daughter #delirium

Sedated for "agitation." Pelvic fracture found 2 days later. The agitation was pain. It very often is, especially in surgical patients. When someone is agitated & delirious, the first question isn't "what do we give them?" - It's "what's causing this?" Pain. Infection. Urinary retention. Constipation. Hypoxia. The list of treatable causes is long.  ↳ A systematic head to toe approach is always needed when evaluating the possible triggers. #delirium #medtwitter

💡 One of the most important findings in delirium research in recent years, and I think it's still not widely enough known. The DECIDE study (Richardson et al, Age and Ageing 2021) followed 305 older adults from the population-based CFAS II-Newcastle cohort. They compared cognitive trajectories in three groups: hospitalised with delirium, hospitalised without delirium, and a matched group who weren't admitted to hospital at all. The hospitalised patients who didn't develop delirium had essentially the same cognitive trajectory as those who were never admitted. No significant difference. But those who developed delirium during their admission showed a 2.2-point MMSE decline at one year compared to the no-delirium group (P<0.001). Neither the number of admissions nor total length of stay were significant predictors. For years we've assumed that hospital admission itself is bad for the brain. This study suggests the real culprit is delirium. And delirium is something we can detect and, at least partly, prevent. That makes it potentially a modifiable risk factor for dementia - at least it means that we need to look into this more and explore the potential benefits of early detection and aggressive treatment aimed at protecting the brain. #medtwitter #dementia

Myth: Sedatives (like benzos) are mostly helpful in calming delirium. Fact: Sedatives often worsen delirium. Non-drug approaches (reorientation, hydration, mobility) are first-line treatments.

⭐ New delirium resource: 50 free clinical cases to practice 4AT #delirium scoring 12 healthcare settings. 3 difficulty levels. Read the case, note your score, then click 'Show Worked Solution'. No login. No ads. Just learning. Please RT & share with colleagues! Link 👇

Another interesting paper on #dementia detection in hospital patients. pubmed.ncbi.nlm.nih.gov/3961…

Emergency Department (ED) staff: screen ALL patients over 65 for delirium. Emergency departments are where it's most missed and most dangerous. Make it as routine as checking blood pressure.