Although delirium is primarily found within aged care facilities and hospital patients, the symptoms of delirium may be the first signs of an untreated medical or mental condition or medication reaction. Causes also include trauma, drug toxicity, bleeding and dehydration. All causes we may come across as first aiders. These may include:
- Medications or drug toxicity
- Alcohol or drug abuse or withdrawal
- A medical condition
- Metabolic imbalances, such as low sodium or low calcium
- Severe, chronic or terminal illness
- Fever and acute infection, particularly in children
- Exposure to a toxin
- Malnutrition or dehydration
- Sleep deprivation or severe emotional distress
- Surgery or other medical procedures that include anesthesia
Delirium involves a quick change between mental states. For example, from lethargy to agitation and back to lethargy. Other symptoms may include:
- Changes in alertness
- Changes in sensation and perception
- Changes in level of consciousness
- Changes in movement. For example: may be slow moving or hyperactive
- Changes in sleep patterns, drowsiness
- Confusion about time or place
- Decrease in short-term memory
- Disorganized thinking, such as talking in a way that doesn’t make sense
- Emotional or personality changes, such as anger, agitation, depression, irritability
- Movements triggered by changes in the nervous system – seizures, tremors
Delirium or Dementia?
Dementia and delirium may be particularly difficult to distinguish, and a person may have both. In fact, frequently delirium occurs in people with dementia. Dementia is the progressive decline of memory and other thinking skills due to the gradual dysfunction and loss of brain cells.
First Aid for the Delirious or Demented
What ever the cause of delerium, how do we render first aid treatment effectively to a severely confused person?
Our primary concern is our own safety and the safety of the ones we are treating. If a person seems delirious it is important to reassure our casualty to enable us to treat them effectively and safely. Which we would try to do anyway, but these specific types of reassurances will help your casualty deal with their situation.
Perform the initial steps to providing first aid, ensuring all dangers have been identified and dealt with and that medical help is on its way. If the person is not requiring immediate resuscitation or action, bear in mind these tips to help reassure your patient as you perform assessment for/of injuries.
- Reassure the person by speaking slowly in a clear voice, identifying yourself and them (if known).
- Knowing the time of day can reduce confusion. Let them know where they are, what day it is and the time of day.
- Visual and hearing impairment can make confusion worse. If you can see they have glasses or hearing aids help them to put on (if safe to do so).
- If aggressive or agitated do not try to restrain. Try to make sure the area is free from hazards.
Agitated or aggressive patients may be dangerous to themselves and others or may not be able to cooperate with necessary procedures.