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Agitated patient management

Cheryl Holly, Sallie Porter, Mercedes Echevarria, Margaret Dreker, Sevara Ruzehaji
The findings can facilitate earlier recognition and prevention of pediatric delirium. ABSTRACT: Purpose: The purpose of this study was to examine the evidence regarding the risk factors for and characteristics of acute pediatric delirium in hospitalized children. METHODS: The systematic review method within an epidemiological framework of person, place, and time was used. Fifty-two studies were selected for initial retrieval. Of these, after assessment for methodological quality, 21 studies involving 2,616 subjects were included in the review...
March 14, 2018: American Journal of Nursing
José Martínez-Raga, Mario Amore, Guido Di Sciascio, Radu Ioan Florea, Marina Garriga, Gabriel Gonzalez, Kai G Kahl, Per-Axel Karlsson, Jens Kuhn, Maria Margariti, Bruno Pacciardi, Konstantinos Papageorgiou, Maurizio Pompili, Fabrice Rivollier, Ángel Royuela, Gemma Safont, Joachim Scharfetter, Bo Skagen, Kazuhiro Tajima-Pozo, Pierre Vidailhet
Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients' care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts' Meeting on Agitation was held in October 2016 in Madrid...
2018: Frontiers in Psychiatry
James B Leonard, Kashif M Munir, Hong K Kim
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP...
March 5, 2018: American Journal of Emergency Medicine
Damiana Scuteri, Laura Rombola, Laura Tridico, Hirokazu Mizoguchi, Chizuko Watanabe, Tsukasa Sakurada, Shinobu Sakurada, Maria TIziana Corasaniti, Giacinto Bagetta, Luigi Antonio Morrone
1.1. BACKGROUND: Alzheimer's Disease (AD) accounts for approximately 50% of all cases of dementia and, in spite of the great effort for the development of disease-modifying drugs, a definitive treatment of cognitive impairment is not available yet. A perfect adherence to the current therapy of cognitive decline is needed for a better control of the disease and this is proven to reduce, though not completely abolish, the associated Behavioural and Psychological Symptoms of Dementia (BPSDs) from occurring...
March 6, 2018: Current Medicinal Chemistry
Francesco Scaglione, Claudio Vampini, Liborio Parrino, Orazio Zanetti
Insomnia is the most common and widespread sleep disorder. Managing insomnia in the elderly patient becomes a difficult challenge for the presence of a multi-disease and multi-drug condition. An organic and functional background that becomes even more fragile when the picture is complicated by psychomotor agitation and cognitive impairment. From the contribution of four experts of different fields and disciplines, stems the need to share an integrated vision that starts from the pharmacological basis of hypnotic drugs, delineates the features of depression in the elderly, addressed the delicate issue of chronic use/abuse of benzodiazepines and ultimately arrives to the management of behavioral disturbances...
January 2018: Rivista di Psichiatria
Rainbow Th Ho, Ted Ct Fong, C Y Sing, Pandora Ht Lee, Alice Bk Leung, Kitty Sm Chung, Janet Kl Kwok
The present study aimed to evaluate the effects of a group music intervention in managing behavioral and psychological symptoms in Chinese elderly with dementia. This cluster randomized trial recruited 73 elderly participants with moderate dementia from 10 elderly residential homes and assigned them to the intervention ( n = 40) and control ( n = 33) group. The intervention included 16 half-hour sessions of music intervention with multi-sensory components over eight weeks and control group received standard care...
January 1, 2018: Dementia
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
Sophee Blanthorn-Hazell, Alfredo Gracia, Jenna Roberts, Anca Boldeanu, Davneet Judge
Background: Agitation is a common feature of bipolar disorder and schizophrenia. Previous research indicates that specific symptoms impact caregiver burden in these conditions, but the impact of agitation on caregiver experience is poorly understood. The aim of this study was to characterise caregiver burden in providers of informal care for patients with bipolar disorder and schizophrenia who experience agitation. Methods: In total, 297 matched patient and caregiver surveys were collected across the UK, Germany and Spain between October 2016 and January 2017...
2018: Annals of General Psychiatry
Leslie S Zun
BACKGROUND: The management of acute agitation in the emergency department often requires the administration of rapid-acting antipsychotic agents. However, there are few comparative studies and little guidance regarding the risks associated with use of such drugs in the acute setting. OBJECTIVE: This structured evidence-based review compared the safety of antipsychotic pharmacotherapies for acute agitation using data from randomized controlled trials identified by a literature search of the PubMed database...
February 9, 2018: Journal of Emergency Medicine
Kerrie Westaway, Oliver Frank, Russell Shute, Anna Moffat, Vanessa LeBlanc, Debra Rowett, Natalie Blacker, Elizabeth Roughead
AIM: Behavioral and psychological symptoms of dementia are often managed inappropriately with antipsychotic medicines. The TOP 5 program, which involves recording up to five relevant and meaningful tips that assist in personalizing care for the person with dementia, has been tested in the hospital setting and transitions of care in Australia, and has been found to be useful. Our study aimed to adapt the TOP 5 program as a strategy to support people with dementia in a primary care setting and to test the acceptability of our adapted TOP 5 program materials...
February 9, 2018: International Journal of Evidence-based Healthcare
Sherily Pereira-Morales, Carmen Mabel Arroyo-Novoa, Annete Wysocki, Lucille Sanzero Eller
CONTEXT: Acute postoperative pain remains inadequately assessed and managed. A valid instrument that assesses acute pain in sedated Post-Anesthesia Care Unit (PACU) patients is needed. OBJECTIVES: Two behavioral pain assessment instruments, the Non-Verbal Pain Scale Revised (NVPS-R) and Critical Care Pain Observation Tool (CPOT), were used to determine if these instruments adequately assess acute pain in the PACU. METHODS: A crossover study design was used...
February 5, 2018: Clinical Journal of Pain
Jacinta Waack, Matthew Shepherd, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Delayed sequence intubation (DSI) involves the administration of ketamine to facilitate adequate preoxygenation in the agitated patient. DSI was introduced into the Clinical Practice Guideline for Intensive Care Flight Paramedics in Victoria in late 2013. We aimed to describe the clinical characteristics of patients receiving DSI. METHODS: A retrospective analysis was undertaken of patients who received DSI between January 1, 2014, and December 31, 2016, during both primary response and retrieval missions...
February 6, 2018: Prehospital Emergency Care
Sadanandavalli Retnaswami Chandra, Safwan Ahamed, Chandra Sasitharan Vidhya Annapoorni
Introduction: Creativity is a physiological need based biological function very essential for survival. However, generally in disorders of progressive cognitive dysfunction creative skills are lost. However there are situations where these potentials are temporarily enhanced. Patients and Methods: We did an observational study of children and adults, 5 adults and 2 childrens, who showed extraordinary creativity evaluated based on evidence shown by patient, peers and re produced in test situation...
January 2018: Indian Journal of Psychological Medicine
T Mauras, A Perony, J Yadak, A Velasco, P Goudal, J-L Marcel
Psychiatric care has always included patients in crisis who are potentially dangerous or agitated. Faced with the many issues they may encounter, the therapeutic relationship has always been prioritized over all other considerations. However, the practice of seclusion and restraint has been steadily increasing in the past few decades. Their use is becoming customary rather than exceptional and consequently fosters less thought by the care teams. In the Healthcare System Modernization Act of January 26th, 2016, the lawmakers sought to underline the freedom-destroying nature of these practices and the necessity of their regulation...
February 2, 2018: L'Encéphale
Michael Gottlieb, Brit Long, Alex Koyfman
BACKGROUND: Acute agitation is a common occurrence in the emergency department (ED) that requires rapid assessment and management. OBJECTIVE: This review provides an evidence-based summary of the current ED evaluation and management of acute agitation. DISCUSSION: Acute agitation is an increasingly common presentation to the ED and has a broad differential diagnosis including metabolic, neurologic, infectious, toxicologic, and psychiatric etiologies...
January 29, 2018: Journal of Emergency Medicine
Kellie Sosnowski, Marion L Mitchell, Hayden White, Lynette Morrison, Joanne Sutton, Jessica Sharratt, Frances Lin
Background: Early rehabilitation has been found to prevent delirium and weakness that can hamper the recovery of intensive care unit (ICU) survivors. Integrated clinical practice guidelines for managing patient pain, agitation and delirium (PAD) have been developed. The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle provides a strategy to implement PAD guidelines into everyday clinical practice. However, there is limited evidence on the effectiveness of the ABCDE bundle in the literature...
2018: Pilot and Feasibility Studies
Vera Feuer, Joshua Rocker, Babar M Saggu, Jason M Andrus, Molly Wormley
Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies...
January 22, 2018: Pediatric Emergency Medicine Practice
Leslie S Zun
BACKGROUND: The main goal of antipsychotic medication in the management of acute agitation in the emergency department is to rapidly induce calm without oversedation, enabling patients to participate in their own care. However, there is a paucity of comparative studies, particularly with newer fast-acting second-generation antipsychotic agents. OBJECTIVE OF THE REVIEW: This structured evidence-based review compared the onset of efficacy of antipsychotic treatments for acute agitation using data from randomized controlled trials identified by a literature search of the PubMed database...
January 17, 2018: Journal of Emergency Medicine
Annie Poirier, Philippe Voyer, France Légaré, Michèle Morin, Holly O Witteman, Edeltraut Kröger, Bernard Martineau, Charo Rodríguez, Anik Mc Giguere
To improve the care of seniors living with dementia, current initiatives typically target better identification and treatment of the patient. Our recent survey, however, shows we should also focus more on the needs of the informal caregivers who care for this population in primary care settings. This three-round Delphi survey sought caregivers' views on the most frequent and difficult decisions that seniors with dementia, their informal caregivers, and health care providers face in primary care settings in the province of Quebec...
January 22, 2018: Canadian Journal of Public Health. Revue Canadienne de Santé Publique
Craig M Dale, Orla Smith, Lisa Burry, Louise Rose
BACKGROUND: Oral care of intubated patients is essential to the prevention of infection and patient discomfort. However, barriers to oral access and delivery of oral care have received little attention. OBJECTIVE: To determine prevalence and predictors of oral access difficulty. DESIGN: A prospective, observational, multi-center study. SETTINGS: Four intensive care units in Toronto, Canada. PARTICIPANTS: Adult patients orally intubated for ≥48 h...
December 28, 2017: International Journal of Nursing Studies
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