Cam Delirium Case Study Questions

Tools

Anticholinergic Burden Scale

This practical tool identifies not only the prescription and over-the-counter medications themselves but classifies them by the severity of their anticholinergic effects on cognition. It also suggests safer alternative medications.

View Anticholinergic Burden Scale

Confusion Assessment Method-ICU Form & Instructions

The CAM-ICU is a delirium monitoring instrument for ICU patients. A complete detailed explanation of how to use the CAM-ICU, as well as answers to frequently asked questions and case studies are provided a manual. More information including videos and materials for downloading are available at ICU Delirium.

View CAM-ICU

Delirium Rating Scale DRS-R-98

Please email Paula Trzepacz for access to this scale.

eCHAMP Delirium Protocol

eCHAMP = Enhancing Care for Hospitalized Older Adults With Memory Problems. These are practical tools physicians and nurses can use to help prevent and manage delirium.

Physician DownloadNurse Download

4AT

The 4AT is a validated rapid assessment test for delirium and cognitive impairment. It is widely used in routine clinical practice in the UK and internationally.

View 4AT

Delirium Education Cards

Professional Education provided by James L. Rudolph, MD

Download

Click on a feature below to learn more.

Feature 1: Acute onset and fluctuating course
This is a change from baseline, AND a change during the day.

This feature is usually obtained from a family member or nurse and is shown by positive responses to the following questions:

  1. Is there evidence of an acute change in mental status from the patient’s baseline?
  2. Did the (abnormal) behaviour fluctuate during the day, that is, tend to come and go, or increase and decrease in severity?

COLLATERAL HISTORY IS ESSENTIAL!

This is difficulty focusing/keeping track, drifting off to sleep, easily distracted.

This feature is shown by a positive response to the following question:

Did the patient have difficulty focusing attention, for example, being easily distractible, or having difficulty keeping track of what was being said?

Can test with 5 item forward digit span; 3 item backward digit span; months of the years backwards; WORLD; serial 7s

Feature 3: Disorganized Thinking
The patient is incoherent, rambling, irrelevant, illogical, circumstantial, vague.

This feature is shown by a positive response to the following question: Was the patient’s thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?

Feature 4: Altered Level of Consciousness
The patient is lethargic, vigilant, stuporous, drowsy, agitated.

This feature is shown by any answer other than “alert” for the following question:

Overall, how would you rate the patient’s level of consciousness? (alert [normal], vigilant [hyperalert], lethargic [drowsy, easily aroused], stupor [difficult to arouse], or coma [unarousable]).

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