Systems-Based Approach to Managing Delirium from POGOe

http://www.gerisage.com/modules/delirium_module/index.htm

http://www.pogoe.org/productid/20815

The links above takes you to the module Systems-Based Approach to Delirium for Multiple Learners-Interactive Web Module. The first one takes you directly to the web-based module and the second is a link to the POGOe products associated with the activity including pdf pocket cards. It’s free and open access from Portal of Geriatric Online Education, at link http://www.pogoe.org/. You can have access to all of the material on this site just by completing a short questionnaire about yourself and creating a username and password. I think it’s an excellent introduction to evaluation, management, and prevention of delirium for learners at different levels including physicians, mid-level providers, resident physicians, medical students, and nurses. The one issue I have with it is that the narrator advises against using intravenous Haloperidol at all. In the real world, physicians, guided by cardiologists and pharmacists, occasionally have to at least consider administering injectable antipsychotic, most often Haloperidol. The reason for caution is that under certain conditions, it can raise the risk for prolongation of cardiac conduction, potentially leading to torsades de pointe (TdP) and possibly leading to ventricular arrhythmias that can raise the risk for mortality. The admittedly imperfect EKG measure for the level of risk for TdP is the corrected QT interval (QTc) on the electrocardiogram (EKG). Most of the time, the recommendation is to avoid using intravenous Haloperidol if the QTc is 500ms or greater. Other risk factors for prolonged QTc include but are not limited to female gender, history of cardiac rhythm problems, abnormal potassium, magnesium, and calcium.

The pdf pocket cards are also nice. Compare them with the pocket card for delirium management made by the Canadian Coalition for Seniors’ Mental Health, the link for which is in the Blogroll on the right of this page. I’ve been using the Mini-Cog for years as a quick cognitive screen. Don’t get tripped up in the Quiz module about the Mini-Cog. It’s not a screener for delirium; it’s an screening instrument for dementia.

There are other similar educational videos and materials available at the Iowa Geriatric Education Center website, the link for which is available in the menu above.

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