After emergency abdominal surgery, one in four patients in today's Danish cohort became delirious, and delirium arrived with the peak of complications. A daily 4AT or CAM takes under two minutes. When it turns positive, examine the abdomen and wound, check lactate, inflammatory markers and electrolytes, look at the drug chart, and scan the bladder. Sedate only after you have looked for a cause.
- Add a daily delirium screen (4AT or CAM) to the post-emergency laparotomy round.
- On a positive screen, examine the abdomen and wound before anything else.
- Check bloods, oxygen saturation, bladder volume and recent drug changes, especially opioids and anticholinergics.
- Tell the family early and involve them in reorientation.
Why it matters
Delirium can be the earliest visible sign that something has gone wrong.
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