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emergency agitation

Lauren R Klein, Brian E Driver, James R Miner, Marc L Martel, Michelle Hessel, Jacob D Collins, Gabriella B Horton, Erik Fagerstrom, Rajesh Satpathy, Jon B Cole
STUDY OBJECTIVE: Agitation in the emergency department (ED) can pose a threat to patient and provider safety; therefore, treatment is indicated. The purpose of this study is to compare haloperidol, olanzapine, midazolam, and ziprasidone to treat agitation. METHODS: This was a prospective observational study of consecutive patients receiving intramuscular medication to treat agitation in the ED. Medications were administered according to an a priori protocol in which the initial medication given was predetermined in the following 3-week blocks: haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, midazolam 5 mg, and haloperidol 10 mg...
June 6, 2018: Annals of Emergency Medicine
Ana Andrade, Catarina Sousa, Mónica Pedro, Martinho Fernandes
Caffeine (1,3,7-trimethylxanthine) is a natural product commonly presented in food's composition, beverages and medicinal products. Generally, it is thought to be safe under normal dosage, yet it can be fatal in case of severe intoxication. We report a case of a healthy 32-year-old woman who went to the local emergency department (ED) 30 min after ingesting, accidentally, 5000 mg of anhydrous caffeine for a preworkout supplement. At the ED, she presented an episode of presyncope followed by agitation. ECG showed polymorphic broad complex QRS tachycardia and arterial blood gas revealed metabolic acidaemia with severe hypokalemia...
June 8, 2018: BMJ Case Reports
Ante Silić, Aleksandar Savić, Ilaria Čulo, Suzana Kos, Jakša Vukojević, Daška Brumen, DraŽenka Ostojić
BACKGROUND: An emergency in psychiatric setting is any disorder in thought process, feelings and/or behavior of the patient that requires urgent therapeutic intervention. In general, we can observe an increase in numbers of psychiatric emergencies throughout the world and in Croatia as well. Agitation and aggression are one of the most common causes of emergency in psychiatry. Agitation is common and frequent in patients suffering from schizophrenia. Patient can be agitated in various levels such as: mild, moderate or severe and can alternate between these levels in the same presentation...
June 2018: Psychiatria Danubina
D P Devanand, Jesse G Strickler, Edward D Huey, Elizabeth Crocco, Brent P Forester, Mustafa M Husain, Ipsit V Vahia, Howard Andrews, Melanie M Wall, Gregory H Pelton
Symptoms of agitation, aggression, and psychosis frequently occur in patients with Alzheimer's disease (AD). These symptoms are distressing to patients and caregivers, often lead to institutionalization, are associated with increased mortality, and are very difficult to treat. Lithium is an established treatment for bipolar and other psychotic disorders in which agitation can occur. The Lit-AD study is the first randomized, double-blind, placebo-controlled trial to assess the efficacy of lithium treatment for symptoms of agitation or aggression, with or without psychosis, in older adults diagnosed with AD...
May 31, 2018: Contemporary Clinical Trials
James W Ochi, Andrew C Richardson
OBJECTIVE: Medical acupuncture is increasingly recognized for reducing postoperative pain, nausea and emergence agitation. Anesthetic induction is an ideal time to perform acupuncture in an effort to reduce the adverse side effects of surgery. Acupuncture is safe, inexpensive and does not lengthen the duration of anesthesia. There are however no published reports of how often patients will choose intraoperative acupuncture when given the opportunity to do so. METHODS: A retrospective review of all surgical procedures performed by one surgeon over 12 months was done...
July 2018: International Journal of Pediatric Otorhinolaryngology
Armando Cester-Martínez, José A Cortés-Ramas, Diego Borraz-Clares, Marta Pellicer-Gayarre
Rapid and effective control of agitated patients is crucial for ensuring their safety and proper management. We present a case series of 12 agitated psychiatric patients who were suitable for treatment with inhaled loxapine in the prehospital emergency setting. Two refused its administration and two required additional treatment. Loxapine was effective within 2-10 minutes, with no adverse effects or sedation. In our experience the use of inhaled loxapine enabled rapid and non-coercive control of agitation in most psychiatric patients, allowing us to avoid mechanical restraint and injectable drugs, and facilitating the transportation and transfer of the patients...
November 2017: Clinical practice and cases in emergency medicine
Michael G Abesamis, Najeeb Taki, Richard Kaplan
A 31-year-old woman presented to an emergency department for suspected vaginal "stuffing" of cocaine. Her physical and pelvic exams were unremarkable despite agitation, tachycardia and hypertension. Abdominal radiograph was concerning for foreign body; transabdominal ultrasound was non-diagnostic. A noncontrast abdominal/pelvic computed tomography (CT) revealed a radiopaque mass within the cervix extending into the uterus. Gynecology was consulted, but the patient refused removal and left against medical advice...
November 2017: Clinical practice and cases in emergency medicine
S K Cordeiro, R C Daro, H Seung, W Klein-Schwartz, H K Kim
BACKGROUND AND AIMS: New synthetic cannabinoid receptor agonists (SCRAs) are synthesized each year to evade U.S. governmental regulation and sold for recreational use. Our aim was to estimate the changes in the clinical effects and patient disposition associated with SCRA exposure from 2010 to 2015. DESIGN: A retrospective observational cohort study SETTING: National Poison Data System that collects data on reports of poisonings from 55 U.S. poison centers. PARTICIPANTS: 19,388 isolated SCRA cases between January 1, 2010 and December 31, 2015 were identified...
May 28, 2018: Addiction
Wataru Takayama, Kaho Yamasaki, Akira Endo, Yasuhiro Otomo
Impalement brain injury is rare, and the initial management of this condition is not well-established. We present a case of a well-managed brain injury caused by impalement with a metal bar. A 29-year-old man whose head had been impaled by a metal bar was transferred to our hospital. Upon arrival, he was agitated, with an unsteady gait and prominent odor of alcohol on his breath. He exhibited normal vital signs and neurological findings, except for his level of consciousness. To address the risk of secondary brain injury caused by movement of the foreign body, we immediately administered a sedative agent and muscle relaxant after the initial neurological evaluation...
2018: Case Reports in Emergency Medicine
Yumi Hirano, Tsukasa Isago, Katsuhiro Kure, Takashi Yamaki
Objective: We report relationship between complications and predictive factors of occurrence with multivariate analysis for cases of laser treatment under general anesthesia.Study Design: Pediatric patients (330 cases, aged 1 to 15 years old) who underwent laser treatment under inpatient general anesthesia against body surface hemangiomas or melanocytosis were examined for the complications. Methods: Retrospective study from medical and anesthesia records, statistical assessment was carried out using multivariate analysis by univariate and logistic regression analysis, and p value less than 0...
March 31, 2018: Laser Therapy
Timothy Reynolds, Sumanna Sankaran, Wilson T Chimbira, Thuy Phan, Olubukola O Nafiu
PURPOSE: Sleep-disordered breathing (SDB) may be a critical risk factor for emergence agitation (EA). We hypothesized that SDB diagnosis is a predictor of EA in children after general anesthesia for ambulatory surgery. DESIGN: Prospective, observational, cohort study. METHODS: Children aged 4 to 17 years were assessed for the occurrence of EA. Differences in probability of EA were assessed using multivariable logistic regression analyses...
June 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Akin Ojagbemi, Bonga Chiliza, Toyin Bello, Laila Asmal, Oluyomi Esan, Robin Emsley, Oye Gureje
Background: Very little is known about the relationship between spontaneous and treatment-induced motor syndromes in Africans with first episode schizophrenia. Objective: We investigated the association between spontaneous NSS and EPS, with treatment-induced EPS in a homogenous sample of Black Africans with first episode schizophrenia. Methods: We examined Xhosa (South Africa) and Yoruba (Nigeria) patients, using the Neurological Evaluation Scale and extrapyramidal symptoms scale before and at 3 months after exposure to low dose flupenthixol decanoate...
2018: Frontiers in Psychiatry
Byron Creese, Miguel Vasconcelos Da Silva, Iskandar Johar, Clive Ballard
Antipsychotics have long been the mainstay of treatment for agitation and psychosis in Alzheimer's disease. Despite their current use successive studies have shown that they only confer a modest benefit which must be balanced against their well-established serious side effects (extrapyramidal symptoms, stroke, accelerated cognitive decline and mortality). Areas covered: This review outlines the current guidance on antipsychotic usage and the evidence of their continued usage against a backdrop of emerging pharmacological treatments and an increasing emphasis on the importance of non-pharmacological interventions...
May 21, 2018: Expert Review of Neurotherapeutics
Pauline B Zablocki-Thomas, Anthony Herrel, Isabelle Hardy, Lucile Rabardel, Martine Perret, Fabienne Aujard, Emmanuelle Pouydebat
A whole suite of parameters is likely to influence the behavior and performance of individuals as adults, including correlations between phenotypic traits or an individual's developmental context. Here, we ask the question whether behavior and physical performance traits are correlated and how early life parameters such as birth weight, litter size, and growth can influence these traits as measured during adulthood. We studied 486 captive gray mouse lemurs ( Microcebus murinus ) and measured two behavioral traits and two performance traits potentially involved in two functions: exploration behavior with pull strength and agitation score with bite force...
May 2018: Ecology and Evolution
Payal Sud, Miles Gordon, Laura Tortora, Matthew Stripp, Damon Borg, Adam Berman
Introduction: Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and bradycardia, contrasting prior reports of SC-induced tachycardia and agitation. Our goal was to describe these novel presentations and characterize the compounds. Methods: We present a case series of patients with SC intoxication who presented to our toxicology service covering two tertiary care EDs between 2/11/2015 and 6/23/2015...
May 2018: Western Journal of Emergency Medicine
Ambrose H Wong, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network...
May 2018: Joint Commission Journal on Quality and Patient Safety
Adelais G Tsiotou, Anna Malisiova, Elena Kouptsova, Maria Mavri, Maria Anagnostopoulou, Evagelia Kalliardou
BACKGROUND: Postanesthesia emergence delirium is a motor agitation state complicating pediatric anesthesia. We investigated the efficacy of dexmedetomidine in reducing emergence delirium in children undergoing tonsillectomy with and without adenoidectomy using total intravenous anesthesia with propofol. METHODS: This was a prospective, single-center, double-blind, randomized study. The primary outcome was the presence or absence of emergence delirium with and without dexmedetomidine...
May 12, 2018: Paediatric Anaesthesia
Phey Yee Goh, Beatrice Huang, Nancy Pehlivan
OBJECTIVE: This case report aims to highlight the challenges faced by mental health clinicians in managing complex medical and psychiatric presentation, with a particular interest in intravenous (IV) olanzapine use outside the emergency department (ED) and intensive care unit setting. CONCLUSION: There is no current prescribing guideline regarding the use of IV olanzapine for acute agitation associated with schizophrenia and bipolar disorder. Most of the literature available regarding the use of IV olanzapine has originated from studies performed in the ED setting, with the majority of studies reporting a favourable efficacy and safety profile for IV olanzapine...
May 1, 2018: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Rajesh Manoharrao Dhoble, Pratap Reddy Maddigapu, Anand Govind Bhole, Sadhana Rayalu
Novel low-cost bark-based magnetic iron oxide particles (BMIOPs) were synthesized and investigated for the removal of As(III) in drinking water. The synthesized BMIOP had a saturation magnetization value of 38.62 emug-1 which was found to be enough for the magnetic separation of exhausted BMIOP after As(III) adsorption. Parameters like agitation speed, adsorbent dosage, contact time, pH, temperature, and initial concentration were thoroughly investigated. Langmuir, Freundlich, and Dubinin-Radushkevich isotherms were used for the modeling of experiments and observed a maximum adsorption (19...
May 7, 2018: Environmental Science and Pollution Research International
Nurlin Abu Samah, María-Jesús Sánchez-Martín, Rosa Mª Sebastián, Manuel Valiente, Montserrat López-Mesas
Contaminants of Emerging Concerns (CECs) have been introduced as one type of recalcitrant pollutant sources in water. In this study, the non-steroidal anti-inflammatory drug diclofenac (DCF) has been removed from water solutions using Molecularly Imprinted Polymer (MIP), synthetized via bulk polymerization with allylthiourea (AT) as the functional monomer and using DCF as template (MIP-DCF). DCF detection has been performed by UV spectrophotometer. From the kinetic study in batch mode, approximately 100% of removal is observed by using 10mg of MIP-DCF, with an initial concentration of 5mg/L of DCF at pH7, within 3min and agitated at 25°C...
August 1, 2018: Science of the Total Environment
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