Neurology Book

Approach

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CAM-ICU

Aka: CAM-ICU, Confusion Assessment Method of the Intensive Care Unit
  1. See Also
    1. Confusion Assessment Method
    2. CAM-S (Confusion Assessment Method Short Form)
    3. bCAM (Brief Confusion Assessment Method)
    4. Delirium
  2. Indications
    1. Delirium Evaluation
  3. Technique:
    1. Step 1: Altered Mental Status change from baseline or fluctuating course over prior 24 hours
      1. Positive
        1. Go to Step 2
      2. Negative
        1. Stop - Negative for Delirium
    2. Step 2: Inattention present
      1. Technique
        1. Examiner: "Squeeze my hand when you hear the letter A"
        2. Examiner says the following letters (with 4 A's), one at a time "S-A-V-E-A-H-A-A-R-T"
      2. Positive -More than 2 errors (missed at least 2 A's)
        1. Go to step 3
      3. Negative
        1. Stop - Negative for Delirium
    3. Step 3: Altered Level of Consciousness present
        1. Assign Richmond Agitation Sedation Scale (RASS) Score Positive (RASS score abnormal, not 0)
        2. Stop - POSITIVE for Delirium
      1. Negative (RASS Score 0)
        1. Go to Step 4
    4. Step 4: Disorganized Thinking
      1. Questions
        1. "Will a stone float on water?"
        2. "Are there fish in the sea?"
        3. "Does one pound weigh more than two pounds?"
        4. "Can you use a hammer to pound a nail?"
      2. Command
        1. Examiner: "Hold up this many fingers"
          1. Examiner holds up 2 fingers
          2. Patient should hold up 2 fingers with one hand
        2. Examiner: "Now do the same thing with the other hand"
          1. Examiner does not demonstrate this time
          2. Patient should hold up 2 finger on the opposite hand
          3. Alternatively (if patient unable to move both hands): "Now hold up 3 fingers"
      3. Positive (2 or more errors)
        1. POSITIVE for Delirium
      4. Negative (0 or 1 error)
        1. Negative for Delirium
  4. Efficacy: Delirium Diagnosis
    1. Test Sensitivity: 72% (68% if non-physician performs)
    2. Test Specificity: 99%
  5. Resources
    1. Vanderbilt ICU Delirium
      1. http://icudelirium.org/delirium/monitoring.html
  6. References
    1. Ely (2001) Crit Care Med 29:1370-9 -Inouye (1990) Ann Intern Med 113: 941-8 [PubMed]

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