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https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#1
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27901329/comparing-incidence-of-emergence-delirium-between-sevoflurane-and-desflurane-in-children-following-routine-otolaryngology-procedures
#2
Jeremy N Driscoll, Brian M Bender, Carlos A Archilla, Carol M Klim, J Hossain, George Mychaskiw, Julie L Wei
BACKGROUND: Emergence delirium (ED) is a state of aggressive agitation that can occur temporarily in the process of emerging from anesthesia in children exposed to volatile or intravenous anesthetics. Emergence delirium is typically assessed using the published and validated pediatric emergence delirium (PAED) scale. Due to some variation in properties between sevoflurane and desflurane for maintenance of anesthesia after standard sevoflurane induction, we designed a prospective study to examine potential differences in emergence behavior and incidence of ED in children undergoing elective ear-nose-throat (ENT) surgery...
November 30, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27890467/use-of-hyperbaric-oxygen-therapy-and-pegylated-carboxyhemoglobin-bovine-in-a-jehovah-s-witness-with-life-threatening-anemia-following-postpartum-hemorrhage
#3
K Thenuwara, J Thomas, M Ibsen, U Ituk, K Choi, E Nickel, M J Goodheart
We present a case of a Jehovah's Witness patient who refused blood products, with the exception of albumin and clotting factors, and underwent cesarean section under spinal anesthesia complicated by postpartum hemorrhage. She was fluid resuscitated and treated with multiple uterotonics and internal iliac artery embolization. Because of agitation she required emergency tracheal intubation. Her hemoglobin concentration dropped from a preoperative value of 12mg/dL to 3mg/dL on postoperative day one. She was acidotic, requiring vasopressors for hemodynamic stability and remained ventilated and sedated...
October 24, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27888959/bearing-witness-the-lived-experience-of-sitting-with-patients
#4
Rebecca Schroeder
There is abundant literature focused on the practice of using hospital sitters as part of standard patient safety care. However, minimal attention has been paid to understanding the actual experiences of hospital workers as they sit with distressed and often agitated patients. With the overwhelming number of hospitalized patients who require sitters, attention must be paid to the healthcare workers' perspective. In this study a phenomenological approach was used to elicit the perceptions of these hospital sitters...
December 2016: Archives of Psychiatric Nursing
https://www.readbyqxmd.com/read/27885664/haloperidol-plus-promethazine-for-psychosis-induced-aggression
#5
REVIEW
Gisele Huf, Jacob Alexander, Pinky Gandhi, Michael H Allen
BACKGROUND: Health services often manage agitated or violent people, and such behaviour is particularly prevalent in emergency psychiatric services (10%). The drugs used in such situations should ensure that the person becomes calm swiftly and safely. OBJECTIVES: To examine whether haloperidol plus promethazine is an effective treatment for psychosis-induced aggression. SEARCH METHODS: On 6 May 2015 we searched the Cochrane Schizophrenia Group's Register of Trials, which is compiled by systematic searches of major resources (including MEDLINE, EMBASE, AMED, BIOSIS, CINAHL, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings...
November 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27882039/pediatric-tooth-extractions-under-sedoanalgesia
#6
Ayse Hande Arpaci, Berrin Isik
OBJECTIVE: The present study aims to evaluate intravenous ketamine and inhalation sedation in children, their unwanted side-effects and surgeon satisfaction. METHODS: In this study, data of 922 children aged between 1-18 who underwent tooth extraction under sedoanalgesia in our department between September 2015-January 2016 were gathered and anesthesia approaches, unwanted side effects and surgical satisfaction was investigated. Postoperative recovery emergence agitation or delirium was evaluated with Watcha Behavior Scale (WBS)...
September 2016: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/27874191/nitrate-and-nitrite-determination-in-gunshot-residue-samples-by-capillary-electrophoresis-in-acidic-run-buffer
#7
Özge Ö Erol, Behice Y Erdoğan, Atiye N Onar
Simultaneous determination of nitrate and nitrite in gunshot residue has been conducted by capillary electrophoresis using an acidic run buffer (pH 3.5). In previously developed capillary electrophoretic methods, alkaline pH separation buffers were used where nitrite and nitrate possess similar electrophoretic mobility. In this study, the electroosmotic flow has been reversed by using low pH running buffer without any additives. As a result of reversing the electroosmotic flow, very fast analysis has been actualized, well-defined and separated ion peaks emerge in less than 4 min...
November 22, 2016: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/27857778/state-of-acute-agitation-at-psychiatric-emergencies-in-europe-the-stage-study
#8
Luis San, Josef Marksteiner, Peter Zwanzger, María Aragüés Figuero, Francisco Toledo Romero, Grigorios Kyropoulos, Alberto Bessa Peixoto, Roxana Chirita, Anca Boldeanu
BACKGROUND: Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. OBJECTIVE: An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. METHOD: For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered...
2016: Clinical Practice and Epidemiology in Mental Health: CP & EMH
https://www.readbyqxmd.com/read/27843954/continuous-quadrupole-magnetic-separation-of-islets-during-digestion-improves-purified-porcine-islet-viability
#9
Bradley P Weegman, Venkata Sunil Kumar Sajja, Thomas M Suszynski, Michael D Rizzari, William E Scott Iii, Jennifer P Kitzmann, Kate R Mueller, Thomas R Hanley, David J Kennedy, Paul W Todd, Appakalai N Balamurugan, Bernhard J Hering, Klearchos K Papas
Islet transplantation (ITx) is an emerging and promising therapy for patients with uncontrolled type 1 diabetes. The islet isolation and purification processes require exposure to extended cold ischemia, warm-enzymatic digestion, mechanical agitation, and use of damaging chemicals for density gradient separation (DG), all of which reduce viable islet yield. In this paper, we describe initial proof-of-concept studies exploring quadrupole magnetic separation (QMS) of islets as an alternative to DG to reduce exposure to these harsh conditions...
2016: Journal of Diabetes Research
https://www.readbyqxmd.com/read/27842924/dexmedetomidine-use-in-the-emergency-department-for-control-of-methamphetamine-induced-agitation-a-report-of-two-cases
#10
Rex Pui Kin Lam, Wai Lam Yip, Chi Keung Wan, Matthew Sik Hon Tsui
BACKGROUND: Chemical restraint is often required to control agitation induced by methamphetamine. Dexmedetomidine is an α-2 adrenergic receptor agonist with sedative, analgesic, and sympatholytic properties. Its use in the emergency department (ED) to control methamphetamine-induced agitation has not been reported. OBJECTIVE: To report two cases of methamphetamine-induced agitation successfully sedated with dexmedetomidine in the ED. CASE REPORT: The first case was a 42-year-old man with unstable emotion and violent behaviours after smoking methamphetamine...
November 3, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833480/a-comparison-of-oral-midazolam-and-oral-dexmedetomidine-as-premedication-in-pediatric-anesthesia
#11
V Jannu, R S Mane, M G Dhorigol, C S Sanikop
CONTEXT: Oral premedication is widely used in pediatric anesthesia to provide preoperative anxiolysis and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but newer drugs such as the α2-agonists have emerged as alternatives for premedication in children. AIMS: The aim of this study was to compare clinical effects of oral midazolam and oral dexmedetomidine on preanesthetic sedation and postoperative recovery profile in children...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27830713/efficacy-and-acceptability-of-different-auxiliary-drugs-in-pediatric-sevoflurane-anesthesia-a-network-meta-analysis-of-mixed-treatment-comparisons
#12
Wuchao Wang, Panchuan Huang, Weiwei Gao, Fangli Cao, Mingling Yi, Liyong Chen, Xiaoli Guo
Emergence agitation preventive medicine should be combined with pediatric anesthesia because of the high frequency of emergence agitation. However, it is challenging to determine the most appropriate medication that can be introduced into pediatric anesthesia for the sake of emergence agitation prevention. We reviewed and retrieved the data from PubMed and Embase. Various medications were assessed based on several endpoints including Emergence agitation outcomes (EA), postoperative nausea and vomiting (PONV), the number of patients who required analgesic (RA), pediatric anesthesia emergence delirium (PAED), the extubation time, the emergency time and the duration of post-anesthesia care unit (PACU) stay...
November 10, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27828781/tracheal-extubation-of-patients-with-cervical-spine-injury-a-case-report-and-review-of-literature
#13
Aleksandra Nowicka, Narcis Ungureanu, Shyam Balasubramanian, Cyprian Mendonca
In patients with cervical spine injuries, emergence from anesthesia and tracheal extubation can prove as challenging to the anesthesiologist as the tracheal intubation. We report a case of a patient with a potentially unstable cervical spine injury who presented for a nonspinal surgery and experienced agitation on emergence from anesthesia. The use of an intravenous sedative was necessary to ensure cervical spine immobilization but was complicated by severe respiratory depression and the need for reintubation and admission to intensive care...
November 8, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27826871/anti-n-methyl-d-aspartate-receptor-encephalitis-after-herpes-simplex-virus-associated-encephalitis-an-emerging-disease-with-diagnosis-and-therapeutic-challenges
#14
Flora Schein, Amandine Gagneux-Brunon, Jean-Christophe Antoine, Sylvie Lavernhe, Sylvie Pillet, Stéphane Paul, Anne Frésard, Claire Boutet, Rémi Grange, Céline Cazorla, Frédéric Lucht, Elisabeth Botelho-Nevers
INTRODUCTION: Morbidity and mortality of Herpes simplex virus encephalitis (HSE) remain high. Relapses of neurological signs may occur after initial clinical improvement under acyclovir treatment. METHODS: We report here a case of post-HSE anti-N-methyl-d-aspartate receptor-mediated encephalitis in an adult and perform a systematic search on PubMed to identify other cases in adults. RESULTS: We identified 11 previously published cases, to discuss diagnostic and therapeutic management...
November 8, 2016: Infection
https://www.readbyqxmd.com/read/27826189/behavioral-emergency-in-the-elderly-a-descriptive-study-of-patients-referred-to-an-aggression-response-team-in-an-acute-hospital
#15
Daniel Simpkins, Carmelle Peisah, Irene Boyatzis
AIM: The management of severely agitated elderly patients is not easy, and limited guidelines are available to assist practitioners. At a Sydney hospital, an Aggression Response Team (ART) comprising clinical and security staff can be alerted when a staff member has safety concerns. Our aims were to describe the patient population referred for ART calls, reasons for and interventions during ART calls, and complications following them. METHODS: Patients 65 years and older referred for ART calls in the emergency department or wards during 2014 were identified using the Incident Information Management System database and medical records were reviewed...
2016: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/27824777/antipsychotic-selection-for-acute-agitation-and-time-to-repeat-use-in-a-psychiatric-emergency-department
#16
Seth Gomez, Julie Dopheide
BACKGROUND: Early recognition and treatment of agitated patients is essential to avoid violence in the psychiatric emergency department (ED). Antipsychotics have established efficacy in managing agitation, yet little is known about how the choice of initial antipsychotic impacts time to repeat use and length of stay (LOS) in the psychiatric ED. OBJECTIVE: To describe the impact of initial antipsychotic selection on time to repeat use and LOS in the psychiatric ED...
November 2016: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/27815834/preventing-emergence-agitation-using-ancillary-drugs-with-sevoflurane-for-pediatric-anesthesia-a-network-meta-analysis
#17
Xin Wang, Qi Deng, Bin Liu, Xiangdi Yu
Using sevoflurane for pediatric anesthesia plays a pivotal role in surgeries. Emergence agitation (EA) is a major adverse event accompanied with pediatric anesthesia. Other anesthetic adjuvants can be combined with sevoflurane in clinical practices for different purposes. However, it is uncertain that such a practice may have substantial influence on the risk of EA. We conducted a literature search in online databases, including PubMed, Embase, Cochrane Library, and Clinical Trials. Key data were extracted from eligible randomized control trials (RCTs)...
November 4, 2016: Molecular Neurobiology
https://www.readbyqxmd.com/read/27800541/intravenous-morphine-vs-intravenous-ketofol-for-treating-renal-colic-a-randomized-controlled-trial
#18
Gholamreza Faridaalaee, Neda Mohammadi, Seyedeh Zahra Merghati, Fatemeh Keyghobadi Khajeh, Bahman Naghipour, Mahboob Pouraghaei, Sajjad Ahmadi
INTRODUCTION: The main purpose of emergency department (ED) management for renal colic is prompt pain relief. The present study aimed to compare the analgesic effects of intravenus (IV) ketofol with morphine in management of ketorolac persistent renal colic. METHODS: This study is a single blind randomized, clinical trial, on patients who were presented to ED with renal colic, whose pain was resistant to 30 mg IV ketorolac. The patients were randomly assigned to either IV morphine (0...
November 2016: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/27798810/emergence-delirium-in-pediatric-anesthesia
#19
REVIEW
Arthura D Moore, Doralina L Anghelescu
Emergence delirium (ED) is a complex of perceptual disturbances and psychomotor agitation that occurs most commonly in preschool-aged children in the early postanesthetic period. The incidence of ED varies between 10 and 80% in children and is perceived as a troublesome clinical situation by 42% of pediatric anesthesiologists. Although these events are often short lived, they increase the risk of self-injury and delayed discharge, require additional nursing staff and can increase medical care costs, all of which are causes for concern...
October 31, 2016: Paediatric Drugs
https://www.readbyqxmd.com/read/27793241/seizure-due-to-multiple-drugs-intoxication-a-case-report
#20
Handan Gulec, Munire Babayigit, Aysun Kurtay, Mehmet Sahap, Fatma Ulus, Zehra Tutal, Eyup Horasanli
The mechanism of the antidepressant effect of bupropion is not fully understood. Besides, using it in the treatment of depression, it is found to be effective in reducing withdrawal symptoms due to smoking cessation. A 28-year-old female patient with a history of depression was admitted to emergency department an hour after ingestion of bupropion, quetiapine, and levothyroxine in high doses to commit suicide. While accepting her into the Intensive Care Unit, she was awake, alert, disoriented and agitated. After 2h, the patient had a generalized tonic-clonic seizure...
November 2016: Brazilian Journal of Anesthesiology
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