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Agitated patient management

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https://www.readbyqxmd.com/read/29791238/low-dose-ketamine-infusion-for-adjunct-management-during-vaso-occlusive-episodes-in-adults-with-sickle-cell-disease-a-case-series
#1
Nicole Palm, Catherine Floroff, Tanna B Hassig, Alice Boylan, Julie Kanter
The optimal management of recurrent painful episodes in individuals living with sickle cell disease (SCD) remains unclear. Currently, the primary treatment for these episodes remains supportive, using fluids and intravenous opioid and anti-inflammatory medications. Few reports have described the use of adjunct subanesthetic doses of ketamine to opioids for treatment of refractory pain in SCD. This article reports a retrospective case series of five patients admitted to the intensive care unit (ICU) with prolonged vaso-occlusive episodes (VOEs)...
May 23, 2018: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/29776706/gaps-in-pain-agitation-and-delirium-management-in-intensive-care-outputs-from-a-nurse-workshop
#2
REVIEW
Carsten Hermes, Maria Acevedo-Nuevo, Andrea Berry, Thomas Kjellgren, Alessandra Negro, Paola Massarotto
Significant improvements in our understanding of pain, agitation, and delirium management within the Intensive Care Unit have been made in recent years. International guidelines and implementation bundles have become more evidence-based, patient-centred, and provide clear recommendations on the best-practice management of critically ill patients. However, the intensive care community has highlighted the need for higher-order evidence in several areas of pain, agitation and delirium research and studies suggest that a significant number of intensive care patients still receive outdated treatment as a consequence of inadequate guideline implementation...
May 15, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29762074/use-of-artificial-hydration-at-the-end-of-life-a-survey-of-australian-and-new-zealand-palliative-medicine-doctors
#3
Jacqueline Oehme, Caitlin Sheehan
BACKGROUND: Dying is ubiquitous, yet the optimal management of hydration in the terminal phase is undetermined. Palliative care (PC) doctors' practices may act as a de facto measure of the benefits and burdens of artificial hydration (AH) use. OBJECTIVE: To identify PC doctors' AH prescribing practices for imminently dying patients and possible influencing factors. METHODS: An online survey of doctors belonging to the Australian and New Zealand Society of Palliative Medicine...
May 15, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29759261/deriving-a-framework-for-a-systems-approach-to-agitated-patient-care-in-the-emergency-department
#4
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
https://www.readbyqxmd.com/read/29745723/management-of-a-complex-patient-intravenous-olanzapine-use
#5
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
https://www.readbyqxmd.com/read/29742583/adjunct-ketamine-use-in-the-management-of-severe-ethanol-withdrawal
#6
Anthony F Pizon, Michael J Lynch, Neal J Benedict, Joseph H Yanta, Adam Frisch, Nathan B Menke, Greg S Swartzentruber, Andrew M King, Michael G Abesamis, Sandra L Kane-Gill
OBJECTIVES: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal. DESIGN: Retrospective observational cohort study. SETTING: Academic tertiary care hospital. PATIENTS: Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria...
May 8, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29724638/placid-study-a-randomized-trial-comparing-the-efficacy-and-safety-of-inhaled-loxapine-versus-intramuscular-aripiprazole-in-acutely-agitated-patients-with-schizophrenia-or-bipolar-disorder
#7
Luis San, Gemma Estrada, Natalia Oudovenko, Francisco Montañés, Natalia Dobrovolskaya, Olga Bukhanovskaya, Mikhail Popov, Eduard Vieta
The aim of the study was to investigate the efficacy and safety of inhaled loxapine compared with the intramuscular (IM) antipsychotic aripiprazole in acutely agitated patients with schizophrenia or bipolar I disorder. PLACID was an assessor-blind, parallel-group trial conducted in 23 centres in the Czech Republic, Germany, Spain, and Russia. Patients (aged 18-65 years) diagnosed with schizophrenia or bipolar I disorder experiencing acute agitation (Clinical Global Impression [CGI]-Severity score ≥ 4) while hospitalized or attending an emergency room were randomized to receive up to two doses of inhaled loxapine 9...
May 1, 2018: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/29723236/health-management-and-pattern-analysis-of-daily-living-activities-of-people-with-dementia-using-in-home-sensors-and-machine-learning-techniques
#8
Shirin Enshaeifar, Ahmed Zoha, Andreas Markides, Severin Skillman, Sahr Thomas Acton, Tarek Elsaleh, Masoud Hassanpour, Alireza Ahrabian, Mark Kenny, Stuart Klein, Helen Rostill, Ramin Nilforooshan, Payam Barnaghi
The number of people diagnosed with dementia is expected to rise in the coming years. Given that there is currently no definite cure for dementia and the cost of care for this condition soars dramatically, slowing the decline and maintaining independent living are important goals for supporting people with dementia. This paper discusses a study that is called Technology Integrated Health Management (TIHM). TIHM is a technology assisted monitoring system that uses Internet of Things (IoT) enabled solutions for continuous monitoring of people with dementia in their own homes...
2018: PloS One
https://www.readbyqxmd.com/read/29718649/synthetic-drug-intoxication-in-children-recognition-and-management-in-the-emergency-department-digest
#9
Rahul Shah, Carl R Baum, Kathryn H Pade
When children and adolescents present to the emergency department with agitation or mental status changes, intoxication from synthetic drug use should be in the differential diagnosis. Identifying the responsible compound(s) may be difficult, so asking the patient broad questions and utilizing appropriate diagnostic studies, when indicated, will aid in making the diagnosis and help identify more-serious complications. This issue discusses the challenges presented by the changing chemical formulations of synthetic cannabinoids, cathinones, and phenethylamines; outlines common presentations of intoxication from these substances; and summarizes best practices for evaluating and managing patients who present with intoxication after consumption of these synthetic drugs of abuse...
May 1, 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29698346/a-mixed-presentation-of-serotonin-syndrome-vs-neuroleptic-malignant-syndrome-in-a-12-year-old-boy
#10
Christie Sun, Hannah Sweet, Alicia B Minns, Desiree Shapiro, Willough Jenkins
BACKGROUND: Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy. CASE: A 12-year-old boy with a history of developmental delay, attention-deficit hyperactivity disorder, and posttraumatic stress disorder presented to the emergency department with behavior changes consisting of delayed reactions, gait instability, drooling, and slowed movements...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29697923/synthetic-drug-intoxication-in-children-recognition-and-management-in-the-emergency-department
#11
Rahul Shah, Carl R Baum
When children and adolescents present to the emergency department with agitation or mental status changes, intoxication from synthetic drug use should be in the differential diagnosis. Identifying the responsible compound(s) may be difficult, so asking the patient broad questions and utilizing appropriate diagnostic studies, when indicated, will aid in making the diagnosis and help identify more-serious complications. This issue discusses the challenges presented by the changing chemical formulations of synthetic cannabinoids, cathinones, and phenethylamines; outlines common presentations of intoxication from these substances; and summarizes best practices for evaluating and managing patients who present with intoxication after consumption of these synthetic drugs of abuse...
May 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29685062/prospective-observational-evaluation-of-sedation-and-pain-management-guideline-adherence-across-new-jersey-intensive-care-units
#12
Alison Brophy, Maria Cardinale, Liza B Andrews, Justin B Kaplan, Christopher Adams, Yekaterina Opsha, Kimberly A Brandt, Deepali Dixit, Steven F Nerenberg, Julie A Saleh
BACKGROUND: The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. OBJECTIVE: This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). METHODS: Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29682241/drug-administration-adjustments-for-elderly-patients-with-dysphagia-a-case-report
#13
Patrícia de Carvalho Mastroianni, Marcela Forgerini
An elderly patient, aged 76 years, diagnosed with dysphagia, depression, hypothyroidism, Alzheimer's disease and mild cognitive deficit, was identified with sertraline and levothyroxine- drug-related problems. Medication Therapy Management (MTM) was used to adjust therapy to the patient's needs by macerating sertraline tablets and solubilizing them in 10-30 mL of orange juice. The patient was advised to take levothyroxine after fasting. Six months later, pharmaceutical follow-up identified an increase in the Mini-Mental State Exam score from 22 to 26 and a decrease in the Clinical Dementia Rating (CDR) scale score from 1...
January 2018: Dementia & Neuropsychologia
https://www.readbyqxmd.com/read/29661160/characterizing-the-experience-of-agitation-in-patients-with-bipolar-disorder-and-schizophrenia
#14
Jenna Roberts, Alfredo Gracia Canales, Sophee Blanthorn-Hazell, Anca Craciun Boldeanu, Davneet Judge
BACKGROUND: Agitation is a common manifestation of bipolar disorder and schizophrenia which includes symptoms ranging from inner tension and unease to violence and aggression. Much of the existing literature has focused on agitation in the acute setting, with the patient experience poorly defined. Thus, the aim of this study was to characterize agitation and its management from a patient perspective, with the focus on those who reside in the community. METHODS: Surveys were completed across Germany, Spain and the UK by 583 community dwelling patients with schizophrenia or bipolar disorder who experienced episodes of agitation...
April 16, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29656713/symptom-management-nutrition-and-hydration-at-end-of-life-a-qualitative-exploration-of-patients-carers-and-health-professionals-experiences-and-further-research-questions
#15
Jessica Baillie, Despina Anagnostou, Stephanie Sivell, Jordan Van Godwin, Anthony Byrne, Annmarie Nelson
BACKGROUND: Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients' symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives' distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives...
April 16, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29623620/economic-evaluation-of-midazolam-droperidol-combination-versus-droperidol-or-olanzapine-for-the-management-of-acute-agitation-in-the-emergency-department-a-within-trial-analysis
#16
Celene Y L Yap, Ya-Seng Arthur Hsueh, Jonathan C Knott, David McD Taylor, Esther W Chan, David C M Kong
BACKGROUND: The combination of midazolam and droperidol has proven superior to droperidol or olanzapine monotherapy in the management of acute agitation in emergency departments (EDs). OBJECTIVE: This is the first economic analysis to evaluate the cost-benefit and cost effectiveness of the midazolam-droperidol combination compared with droperidol or olanzapine for the management of acute agitation in EDs. METHODS: This analysis used data derived from a randomised, controlled, double-blind clinical trial conducted in two metropolitan Australian EDs between October 2014 and August 2015...
July 24, 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29613919/addressing-dual-patient-and-staff-safety-through-a-team-based-standardized-patient-simulation-for-agitation-management-in-the-emergency-department
#17
Ambrose H Wong, Marc A Auerbach, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
INTRODUCTION: Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management...
April 3, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/29610916/should-this-patient-receive-prophylactic-medication-to-prevent-delirium-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#18
Anjala V Tess, Melissa L P Mattison, Joshua R Leo, Eileen E Reynolds
In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal...
April 3, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29605483/severe-opioid-withdrawal-precipitated-by-vivitrol%C3%A2
#19
R S Wightman, L S Nelson, J D Lee, L M Fox, S W Smith
The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM extended release naltrexone (XRNTX;Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse...
March 21, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29580965/designing-a-nurse-delivered-delirium-bundle-what-intensive-care-unit-staff-survivors-and-their-families-think
#20
Leona Bannon, Jennifer McGaughey, Mike Clarke, Daniel F McAuley, Bronagh Blackwood
BACKGROUND: Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation. OBJECTIVE: The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation...
May 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
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