BOF: 2.44
You are called in to see a patient on the surgical ward.
He is an 84-year-old male who was admitted the previous day with an obstructed
inguinal hernia for which he had surgery, which was uncomplicated and
successful.
He has become confused in the night and is shouting out
that there are wild animals attacking him. He has been trying to run away and
the nursing staff are having difficulty controlling him as he says that they
are trying to steal his money. He is been nursed in a single room. He is
afebrile but it is difficult to examine him thoroughly as he is so agitated.
The surgical house officer wishes to sedate him and asks
you whether he should use diazepam or pethidine. You reply that the most
appropriate drug to use in this situation would be:
a)
Chlorpromazine
b)
Haloperidol
c)
Risperidone
d)
Clozapine
e)
Quietiapine
Answer:
b)
The sudden onset of a confusional state in an elderly
patient admitted to hospital is suggestive of delirium.
The visual hallucinations that he appears to be
experiencing and the delusions lend further support to this.
In delirium psychoactive drugs should be avoided if at
all possible as they too may exacerbate delirium but in this case they appear
to be necessary and the most suitable drug would be haloperidol which may be
administered intramuscularly if required.
Revision Tips
Revise delirium KEYS to SUCCESS
in Medicine page 430-432
