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Agitated patient management

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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/27891229/nicotine-replacement-therapy-for-agitation-and-delirium-management-in-the-intensive-care-unit-a-systematic-review-of-the-literature
#2
Melanie Kowalski, Andrew A Udy, Hayden J McRobbie, Michael J Dooley
BACKGROUND: Active smokers are prevalent within the intensive care setting and place a significant burden on healthcare systems. Nicotine withdrawal due to forced abstinence on admission may contribute to increased agitation and delirium in this patient group. The aim of this systematic review was to determine whether management of nicotine withdrawal, with nicotine replacement therapy (NRT), reduces agitation and delirium in critically ill patients admitted to the intensive care unit (ICU)...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27861180/improving-hospital-survival-and-reducing-brain-dysfunction-at-seven-california-community-hospitals-implementing-pad-guidelines-via-the-abcdef-bundle-in-6-064-patients
#3
Mary Ann Barnes-Daly, Gary Phillips, E Wesley Ely
OBJECTIVES: To track compliance by an interprofessional team with the Awakening and Breathing Coordination, Choice of drugs, Delirium monitoring and management, Early mobility, and Family engagement (ABCDEF) bundle in implementing the Pain, Agitation, and Delirium guidelines. The aim was to study the association between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days in community hospitals. DESIGN: A prospective cohort quality improvement initiative involving ICU patients...
November 17, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27857778/state-of-acute-agitation-at-psychiatric-emergencies-in-europe-the-stage-study
#4
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/27855720/pharmacological-interventions-for-agitation-in-patients-with-traumatic-brain-injury-protocol-for-a-systematic-review-and-meta-analysis
#5
David R Williamson, Anne Julie Frenette, Lisa Burry, Marc M Perreault, Emmanuel Charbonney, François Lamontagne, Marie-Julie Potvin, Jean-François Giguère, Sangeeta Mehta, Francis Bernard
BACKGROUND: Traumatic brain injury (TBI) is a worldwide leading cause of mortality and disability. Among TBI complications, agitation is a frequent behavioural problem. Agitation causes potential harm to patients and caregivers, interferes with treatments, leads to unnecessary chemical and physical restraints, increases hospital length of stay, delays rehabilitation, and impedes functional independence. Pharmacological treatments are often considered for agitation management following TBI...
November 17, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27849239/importance-of-the-use-of-protocols-for-the-management-of-analgesia-and-sedation-in-pediatric-intensive-care-unit
#6
Emiliana Motta, Michele Luglio, Artur Figueiredo Delgado, Werther Brunow de Carvalho
Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27842752/management-of-sedation-and-paralysis
#7
REVIEW
Michael A Fierro, Raquel R Bartz
Sedatives are administered to decrease patient discomfort and agitation during mechanical ventilation and to maintain patient-ventilator synchrony. Titration of infusions and or bolus dosing to maintain light sedation goals according to validated scales is recommended. However, it is important to consider deeper sedation for patients with refractory patient-ventilator dyssynchrony (PVD) to prevent volutrauma and barotrauma. Deep sedation plus muscle relaxants may be required to treat PVD or to reduce oxygen consumption and carbon dioxide production...
December 2016: Clinics in Chest Medicine
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
#8
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
#9
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
#10
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/27800541/intravenous-morphine-vs-intravenous-ketofol-for-treating-renal-colic-a-randomized-controlled-trial
#11
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/27791428/cpr-induced-consciousness-during-out-of-hospital-cardiac-arrest-a-case-report-on-an-emerging-phenomenon
#12
Joshua Pound, P Richard Verbeek, Sheldon Cheskes
BACKGROUND: High quality cardiopulmonary resuscitation (CPR) has produced a relatively new phenomenon of consciousness in patients with vital signs absent. Further research is necessary to produce a viable treatment strategy during and post resuscitation. OBJECTIVE: To provide a case study done by paramedics in the field illustrating the need for sedation in a patient whose presentation was consistent with CPR induced consciousness. Resuscitative challenges are provided as well as potential future treatment options to minimize harm to both patients and prehospital providers...
October 28, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27776827/intranasal-dexmedetomidine-sedation-as-adjuvant-therapy-in-acute-asthma-exacerbation-with-marked-anxiety-and-agitation
#13
Giorgio Cozzi, Sara Lega, Rita Giorgi, Egidio Barbi
We describe 2 patients with acute asthma exacerbation who were admitted to the emergency department (ED) with severe agitation and restlessness as a prominent finding, for which bedside asthma treatment sedation with intranasal dexmedetomidine was performed. In both cases, dexmedetomidine allowed the patients to rest and improved tolerance to treatment. Dexmedetomidine is a unique sedative with an excellent safety profile and minimal effect on respiratory function. These properties render it particularly promising for the management of severe agitation in children admitted to the ED with acute asthma exacerbation...
October 5, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27775164/implementation-of-the-agitated-behavior-scale-in-the-electronic-health-record
#14
Helen John Wilson, Kritis Dasgupta, Kathleen Michael
PURPOSE: The purpose of the study was to implement an Agitated Behavior Scale through an electronic health record and to evaluate the usability of the scale in a brain injury unit at a rehabilitation hospital. DESIGN: A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants, using convenience sampling. METHODS: The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale...
October 24, 2016: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
https://www.readbyqxmd.com/read/27757003/off-label-use-of-dexmedetomidine-for-the-treatment-of-delirium-in-the-intensive-care-unit
#15
Huan Mark Nguyen, Doreen Pon
OBJECTIVE: Evaluate recent clinical studies involving the use of dexmedetomidine (DEX) infusion for the treatment of delirium in the intensive care unit (ICU). METHODS: A literature search was conducted to identify peer-reviewed articles in MEDLINE (1966-June 2016) using the terms sedation, analgesic, dexmedetomidine, delirium, and critically ill adult patients. RESULTS: Two studies in the ICU setting reported the potential benefits of DEX for managing agitation during weaning from mechanical ventilation...
October 2016: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/27756974/managing-behavioural-and-psychological-symptoms-in-dementia
#16
Stephen Macfarlane, Daniel O'Connor
Most patients with dementia have some behavioural and psychological symptoms. While aggression and agitation are easily recognised, symptoms such as apathy may be overlooked. Behavioural and psychological symptoms should be managed without drugs whenever possible. Although there is little evidence to support their use, antipsychotic drugs are often prescribed to people with dementia. Before prescribing it is important to exclude other causes of altered behaviour, such as pain or infection. Some symptoms may be artefacts of memory loss rather than psychosis...
August 2016: Australian Prescriber
https://www.readbyqxmd.com/read/27749432/the-abcde-bundle-a-survey-of-nurses-knowledge-and-attitudes-in-the-intensive-care-units-of-a-national-teaching-hospital-in-italy
#17
Floriana Pinto, Gianni Biancofiore
BACKGROUND: The ABCDE (Awakening and Breathing coordination of daily sedation and ventilator removal trials; Choice of sedative or analgesic exposure; Delirium monitoring and management; and Early mobility and exercise) bundle is a multidisciplinary set of evidence-based practices for improving patient outcomes in the intensive care unit. Nurses are critical to all the bundle's requirements. Therefore, understanding their knowledge, attitudes, and perception of the different bundle's components might help for an easier implementation into everyday clinical practice...
November 2016: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/27746070/use-of-tablet-devices-in-the-management-of-agitation-among-inpatients-with-dementia-an-open-label-study
#18
Ipsit V Vahia, Rujvi Kamat, Cheng Vang, Carolina Posada, Lisa Ross, Sarah Oreck, Alok Bhatt, Colin Depp, Dilip V Jeste, Daniel D Sewell
OBJECTIVE: To investigate the feasibility, safety, and utility of tablet devices as novel nonpharmacologic tools in managing older psychiatric inpatients with agitation and dementia. METHODS: Thirty-six patients at a geriatric psychiatry inpatient unit were provided with tablets when agitated and used various apps on the tablet related to communication, games, music, web browser, and photography during their stay. Study staff documented the frequency, duration, and app usage history and rated the extent to which agitation improved after tablet use...
August 4, 2016: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/27743423/the-patient-care-paradox-an-interprofessional-qualitative-study-of-agitated-patient-care-in-the-emergency-department
#19
Ambrose Hon-Wai Wong, Joan Combellick, Beth Ann Wispelwey, Allison Squires, Maureen Gang
OBJECTIVES: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population in order to provide a broad perspective of ED patient violence...
October 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27688361/safety-of-oral-propranolol-for-the-treatment-of-infantile-hemangioma-a-systematic-review
#20
Christine Léaute-Labrèze, Olivia Boccara, Caroline Degrugillier-Chopinet, Juliette Mazereeuw-Hautier, Sorilla Prey, Geneviève Lebbé, Stéphanie Gautier, Valérie Ortis, Martine Lafon, Agnès Montagne, Alain Delarue, Jean-Jacques Voisard
BACKGROUND AND OBJECTIVES: Given the widespread use of propranolol in infantile hemangioma (IH) it was considered essential to perform a systematic review of its safety. The objectives of this review were to evaluate the safety profile of oral propranolol in the treatment of IH. METHODS: We searched Embase and Medline databases (2007-July 2014) and unpublished data from the manufacturer of Hemangiol/Hemangeol (marketed pediatric formulation of oral propranolol; Pierre Fabre Dermatologie, Lavaur, France)...
September 29, 2016: Pediatrics
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