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https://www.readbyqxmd.com/read/28337083/continuous-infusion-etomidate-in-a-patient-receiving-extracorporeal-membrane-oxygenation
#1
Joseph M LaRochelle, Bonnie Desselle, Janet L Rossi
We describe a 16-year-old, 65-kg male deployed on extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure secondary to ingestion of multiple substances. During his ECMO course, standard sedative and analgesic strategies failed and alternative medications were used. The patient received various dosages of fentanyl, morphine, hydromorphone, clonidine patches, dexmedetomidine, lorazepam, methadone, pentobarbital, olanzapine, and propofol. Despite administration of multiple agents, on day 29 of ECMO the patient experienced elevated blood pressures due to agitation, and continuous infusion etomidate was started...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28328824/early-use-of-noninvasive-techniques-for-clearing-respiratory-secretions-during-noninvasive-positive-pressure-ventilation-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-and-hypercapnic-encephalopathy-a-prospective-cohort-study
#2
Jinrong Wang, Zhaobo Cui, Shuhong Liu, Xiuling Gao, Pan Gao, Yi Shi, Shufen Guo, Peipei Li
Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients.The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28318209/end-of-life-care-managing-common-symptoms
#3
REVIEW
Ross H Albert
Physicians should be proficient at managing symptoms as patients progress through the dying process. When possible, proactive regimens that prevent symptoms should be used, because it is generally easier to prevent than to treat an acute symptom. As swallowing function diminishes, medications are typically administered sublingually, transdermally, or via rectal suppository. Opiates are the medication of choice for the control of pain and dyspnea, which are common symptoms in the dying process. Delirium and agitation may be caused by reversible etiologies, which should be identified and treated when feasible...
March 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28302633/systematic-review-of-systematic-reviews-of-non-pharmacological-interventions-to-treat-behavioural-disturbances-in-older-patients-with-dementia-the-senator-ontop-series
#4
Iosief Abraha, Joseph M Rimland, Fabiana Mirella Trotta, Giuseppina Dell'Aquila, Alfonso Cruz-Jentoft, Mirko Petrovic, Adalsteinn Gudmundsson, Roy Soiza, Denis O'Mahony, Antonio Guaita, Antonio Cherubini
OBJECTIVE: To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). DESIGN: Systematic overview of reviews. DATA SOURCES: PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015). ELIGIBILITY CRITERIA: Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD...
March 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/28300462/an-update-on-the-advancements-in-the-treatment-of-agitation-in-alzheimer-s-disease
#5
Anton P Porsteinsson, Inga M Antonsdottir
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are associated with significant negative outcomes for patients and their caregivers. Agitation, one of the most distressing NPS, lacks well-established long term interventions that are both effective and safe. While nonpharmacological interventions are suggested as first-line treatment, they aren't effective in managing symptoms for every patient, resulting in pharmacological interventions for some patients. Traditionally these interventions consist of off-label use of antipsychotics, sedative/hypnotics, anxiolytics, acetylcholinesterase inhibitors, memantine, and antidepressants; where the efficacy doesn't necessarily outweigh the associated risks...
March 16, 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28298034/a-protocol-for-postoperative-admission-of-elective-craniotomy-patients-to-a-non-icu-or-step-down-setting
#6
Jeffrey E Florman, Deborah Cushing, Lynne A Keller, Anand I Rughani
OBJECTIVE Selecting the appropriate patients undergoing craniotomy who can safely forgo postoperative intensive care unit (ICU) monitoring remains a source of debate. Through a multidisciplinary work group, the authors redefined their institutional care process for postoperative monitoring of patients undergoing elective craniotomy to include transfer from the postanesthesia care unit (PACU) to the neurosurgical floor. The hypothesis was that an appropriately selected group of patients undergoing craniotomy could be safely managed outside the ICU in the postoperative period...
March 3, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28287054/effects-and-feasibility-of-an-exercise-intervention-for-individuals-living-with-dementia-in-nursing-homes-study-protocol
#7
Lindsey Brett, Victoria Traynor, Paul Stapley, Shahla Meedya
BACKGROUND: Worldwide, there are an estimated 35.6 million individuals living with dementia. It is important that non-pharmacological therapies are utilized to help manage the symptoms of dementia, such as agitation, as they are the recommended first approach in best practice guidelines. METHODS: This protocol outlines a randomized controlled trial with a qualitative component which evaluated the effects and feasibility of a physical therapist-led physical exercise intervention on agitation of individuals living with dementia in nursing homes...
March 13, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28286819/pain-management-via-ultrasound-guided-nerve-block-in-emergency-department-a-case-series-study
#8
Amir Nejati, Houman Teymourian, Leili Behrooz, Gholamreza Mohseni
INTRODUCTION: Pain is the most common complaint of patients referring to emergency department (ED). Considering the importance of pain management in ED, this study aimed to investigate the efficacy and feasibility of ultrasound-guided nerve blocks in this setting. METHODS: 46 patients who came to the ED with injured extremities were enrolled in the study and received either femoral, axillary or sciatic nerve block depending on their site of injury (1.5 mg Bupivacaine per kg of patient's weight)...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28273658/acupressure-for-managing-agitation-in-people-with-dementia-design-of-a-protocol-using-the-delphi-technique
#9
Rick Yiu Cho Kwan, Mason Chin Pang Leung, Claudia Kam Yuk Lai
No abstract text is available yet for this article.
March 9, 2017: Complement Med Res
https://www.readbyqxmd.com/read/28266282/halting-antipsychotic-use-in-long-term-care-halt-a-single-arm-longitudinal-study-aiming-to-reduce-inappropriate-antipsychotic-use-in-long-term-care-residents-with-behavioral-and-psychological-symptoms-of-dementia
#10
Tiffany Jessop, Fleur Harrison, Monica Cations, Brian Draper, Lynn Chenoweth, Sarah Hilmer, Juanita Westbury, Lee-Fay Low, Megan Heffernan, Perminder Sachdev, Jacqueline Close, Jenny Blennerhassett, Millicent Marinkovich, Allan Shell, Henry Brodaty
BACKGROUND: Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management...
March 7, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28259526/review-of-intranasally-administered-medications-for-use-in-the-emergency-department
#11
Abby M Bailey, Regan A Baum, Karolyn Horn, Tameka Lewis, Kate Morizio, Amy Schultz, Kyle Weant, Stephanie N Justice
BACKGROUND: Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter. OBJECTIVE: This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine...
March 1, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28247580/analysis-of-non-pharmacological-interventions-attempted-prior-to-pro-re-nata-medication-use
#12
Krystle Martin, Vinita Arora, Ilan Fischler, Renee Tremblay
The aim of the present study was to elucidate what non-pharmacological interventions are applied by nursing staff prior to the administration of psychotropic pro re nata (PRN) medication. Best practices would instruct clinical staff to provide non-pharmacological strategies, such as de-escalation and skills coaching, as the first response to patient distress, anxiety, or agitation. Non-pharmacological strategies might be safer for patients, promote more collaborative relationships, and facilitate greater skills development for managing symptoms...
March 1, 2017: International Journal of Mental Health Nursing
https://www.readbyqxmd.com/read/28236391/best-practices-for-managing-pain-sedation-and-delirium-in-the-mechanically-ventilated-patient
#13
REVIEW
Kitty M Garrett
Nursing management of pain, agitation, and delirium in mechanically ventilated patients is a challenge in critical care. Oversedation can lead to delayed extubation, prolonged ventilator days, unnecessary neurologic testing, and complications such as weakness and delirium. Undersedation can lead to self-extubation, invasive line removal, unnecessary patient distress, and injury to self or others. Acquiring an optimal level of sedation requires the bedside nurse to be more vigilant than ever with patient assessment and medication titration...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28225482/a-case-report-of-posterior-reversible-encephalopathy-syndrome-in-a-patient-receiving-gemcitabine-and-cisplatin
#14
Hannah Cherniawsky, Neesha Merchant, Micheal Sawyer, Maria Ho
RATIONALE: Posterior reversible encephalopathy syndrome (PRES) is a subacute syndrome causing characteristic neurologic and radiologic findings. PRES is predominantly caused by malignant hypertension though it has been associated with immunosuppressive treatments such as chemotherapy. PATIENT CONCERNS: We describe a case of a 58 year old female who developed fluctuant level of consciousness, agitation. DIAGNOSIS: MRI findings were in keeping with posterior reversible encephalopathy syndrome following cycle 6 of palliative gemcitabine and cisplatin therapy for metastatic cholangiocarcinoma...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28222514/one-year-evolution-of-behavioral-and%C3%A2-psychological-symptoms-of-dementia-in-patients-initially-hospitalized-in%C3%A2-cognitive-behavioral-units-the-evital-prospective-cohort
#15
Isabelle Rouch, Elodie Pongan, Béatrice Trombert, Florence Fabre, Nicolas Auguste, Claire Sellier, Magalie Freulon, Sophie Jacqueline, Denis Federico, Christelle Mouchoux, Géraldine Martin-Gaujard, Pierre Krolak-Salmon, Bernard Laurent, Jean-Michel Dorey
BACKGROUND: The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge. OBJECTIVE: The present study investigated the long-term evolution of BPSD over one year after CBU discharge. METHODS: The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals...
2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/28205446/intramuscular-ziprasidone-dosing-for-acute-agitation-in-the-pediatric-emergency-department
#16
Tammy Nguyen, Jillian Stanton, Robin Foster
BACKGROUND: Intramuscular (IM) ziprasidone is often used to manage acute agitation. Limited data exist on the pediatric dosing of ziprasidone in the emergency department (ED). OBJECTIVE: To characterize the mg/kg dosing differences between pediatric ED patients who respond to an initial dose of ziprasidone versus patients who do not. METHODS: This was a retrospective, observational study of 5- to 18-year-old patients who were treated with IM ziprasidone in the pediatric ED from 2007 to 2015...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28196698/-when-and-how-prescribe-antipsychotics
#17
S Tebeka, G Airagnes, F Limosin
Antipsychotics are commonly prescribed in the general population since they have many indications. They can be used in acute care such as agitation or behavior disorders, or to treat more characterized psychiatric disorders like psychotic or mood disorders. Consequently, any practitioner will have to prescribe or renew a prescription of antipsychotics. These treatments require a benefit/risk balance assessment taking into account the specific context of each patient. Indeed, antipsychotics have many side effects, mainly neurological (extrapyramidal syndrome, dyskinesia, akathisia), metabolic and cardiac...
February 10, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#18
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28182021/procedural-moderate-sedation-with-ketamine-in-pediatric-critical-care-unit
#19
Tarek R Hazwani, Hala Al-Alem
OBJECTIVE: To evaluate the safety and efficacy of moderate sedation in the Pediatric Intensive Care Unit (PICU) settings according to moderate sedation protocol using ketamine and midazolam and to determine areas for the improvement in our clinical practice. SETTINGS AND DESIGN: A retrospective study was conducted in the PICU. MATERIALS AND METHODS: Retrospective chart review was performed for patients who had received moderate sedation between January and the end of December 2011 and who are eligible to inclusion criteria...
January 2017: Avicenna Journal of Medicine
https://www.readbyqxmd.com/read/28179250/impact-of-pharmacist-management-of-pain-agitation-and-delirium-in-the-intensive-care-unit-through-participation-in-multidisciplinary-bundle-rounds
#20
Patricia Louzon, Heath Jennings, Mahmood Ali, Marijo Kraisinger
PURPOSE: A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described. SUMMARY: Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients...
February 15, 2017: American Journal of Health-system Pharmacy: AJHP
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