Table 7.

When Delirium is present, “THINK” about “Dr. DRE”

T.H.I.N.K.	Dr. DRE
Toxic Situations	Diseases
CHF, shock, dehydration, deliriogenic medications, new organ failures (e.g., renal, liver)	Sepsis, CHF
Hypoxemia/Hypercarbia	Drug Removal
	Stop deliriogenic medications (e.g benzodiazepines, antihistamines, opioids used for sedation)
Infection, Inflammation, Immobility	Environment
Is there a new nosocomial infection? Can the patient be mobilized?	Remove restraints, provide orientation items including clocks and calendars, reduce isolation mobilize the patient, restore day/night light patterns, reduce noise, promote sleep
Non-pharmacologic Interventions
Assess & treat pain, mobilize the patient, provide hearing aids and eyeglasses, reorient the patient reduce noise, promote sleep
K+ or other electrolyte abnormalities

When the CAM-ICU or ICDSC is positive, the immediate search for potential etiologies and modifiable risk factors should be undertaken. We posit the mnemonics “THINK” and “Dr. DRE” to provide clinicians with a brief list of conditions to consider in a delirious patient. “THINK” mnemonic adapted with permission from Marta Render, MD, Department of Veterans Affairs Inpatient Evaluation Center (IPEC).