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emergency delirium

Mehmet Ali Aslaner, Mustafa Boz, Ali Çelik, Asliddin Ahmedali, Sercan Eroğlu, Nalan Metin Aksu, Serkan Emre Eroğlu
OBJECTIVES: Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. METHODS: This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study...
October 5, 2016: American Journal of Emergency Medicine
Emily McNicholas, Ahmed H Abdelhafiz
Unexplained fever and confusion is a common reason for emergency medical admission. When this occurs in the context of new urinary incontinence, a urinary tract infection may be considered to be the most likely cause. However it is also important to consider spinal pathology when this combination of symptoms arises. We present a case of a retropharygeal collection presenting in a patient with this combination of symptoms.
2016: Acute Medicine
Huimin Lin, Samuel T H Chew
An 85-year-old female with chronic kidney disease and newly acquired seizures on oral phenytoin received intravenous ertapenem 500 mg once daily for a urinary tract infection and bacteraemia involving extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. After three ertapenem doses, she developed seizures which self-aborted. Corrected phenytoin level was sub-therapeutic initially, but became therapeutic following a phenytoin dose increase. On Day 14 of ertapenem, the patient suffered another episode of seizure...
December 2015: Drug Saf Case Rep
Matthew Umholtz, John Cilnyk, Christopher K Wang, Jahan Porhomayon, Leili Pourafkari, Nader D Nader
STUDY OBJECTIVE: Recovery from anesthesia may be complicated with development of severe panic symptoms and anxiety. Preexisting anxiety disorder has been reported as a risk factor for development of these symptoms. We aimed to examine the frequency of emergence delirium (EDL) among veterans diagnosed with posttraumatic stress disorders (PTSDs). DESIGN: Retrospective cohort. SETTING: Postoperative recovery area. PATIENTS: Perioperative information of 1763 consecutive patients who underwent a surgical procedure requiring general anesthesia were collected...
November 2016: Journal of Clinical Anesthesia
Wayne Varndell, Margaret Fry, Doug Elliott
AIM: This systematic review examined the psychometric properties and suitability of the available observational pain instruments for potential use with nonverbal critically ill adult patients in the emergency department. BACKGROUND: In the emergency department assessing pain in critically ill patients is challenging, especially those unable to communicate the presence of pain. Critically ill patients are commonly unable to verbally communicate pain due to altered oral communication (e...
September 29, 2016: Journal of Clinical Nursing
Anne Lingford-Hughes, Yash Patel, Owen Bowden-Jones, Mike J Crawford, Paul I Dargan, Fabiana Gordon, Steve Parrott, Tim Weaver, David M Wood
BACKGROUND: GHB (gamma-hydroxybutyrate) and its pro-drugs GBL (gamma-butyrolactone) and 1,4-butanediol (1,4-BD) are central nervous system depressants whose street names include 'G' and 'liquid ecstasy'. They are used recreationally predominately for their stimulant and pro-sexual effects or for sedation to help with sleep and/or to 'come down' after using stimulant recreational drugs. Although overall population prevalence is low (0.1 %), in some groups such as men who have sex with men, GHB/GBL use may reach 20 %...
September 27, 2016: Trials
Craig Nolan, Lisa M DeAngelis
PURPOSE OF REVIEW: The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment. RECENT FINDINGS: In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy...
September 26, 2016: Current Opinion in Neurology
L K Beales, M Mercuri
A shortcut review was carried out to see if the abbreviated mental test score was better than other cognitive screening tools to diagnose delirium in the ED. Fourteen papers were identified reporting on 10 separate ED studies. Only one small study used the abbreviated mental test score and did not compare the diagnostic performance to any other test. There is very little published research on the use of the abbreviated mental test score in the ED setting.
October 2016: Emergency Medicine Journal: EMJ
Alessandro Morandi, Daniel Davis, Giuseppe Bellelli, Rakesh C Arora, Gideon A Caplan, Barbara Kamholz, Ann Kolanowski, Donna Marie Fick, Stefan Kreisel, Alasdair MacLullich, David Meagher, Karen Neufeld, Pratik P Pandharipande, Sarah Richardson, Arjen J C Slooter, John P Taylor, Christine Thomas, Zoë Tieges, Andrew Teodorczuk, Philippe Voyer, James L Rudolph
Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal...
September 16, 2016: Journal of the American Medical Directors Association
(no author information available yet)
Delirium is the most common neuro-psychiatric syndrome in patients with advanced cancer, but it often goes undetected in the emergency department, research suggests.
August 24, 2016: Nursing Standard
Laura S Bonanno, Stephanie Pierce, Jennifer Badeaux, James J FitzSimons
This review aims to identify the effectiveness of preoperative intranasal dexmedetomidine compared with oral midazolam for the prevention of emergence delirium in pediatric patients undergoing general anesthesia.
August 2016: JBI Database of Systematic Reviews and Implementation Reports
Joel Norton, Christine Hymers, Penelope Stein, Joanne May Jenkins, Duncan Bew
BACKGROUND: Acute porphyria is historically known as "the little imitator" in reference to its reputation as a notoriously difficult diagnosis. Variegate porphyria is one of the four acute porphyrias, and can present with both blistering cutaneous lesions and acute neurovisceral attacks involving abdominal pain, neuropsychiatric features, neuropathy, hyponatremia, and a vast array of other nonspecific clinical features. CASE REPORT: A 40-year-old man presented to the Emergency Department (ED) as a major trauma call, having been found in an "acutely confused state" surrounded by broken glass...
September 10, 2016: Journal of Emergency Medicine
Jin H Han, Nathan E Brummel, Rameela Chandrasekhar, Jo Ellen Wilson, Xulei Liu, Eduard E Vasilevskis, Timothy D Girard, Maria E Carlo, Robert S Dittus, John F Schnelle, E Wesley Ely
OBJECTIVES: To determine how delirium subtyped by level of arousal at initial presentation affects 6-month mortality. DESIGN: This was a preplanned secondary analysis of two prospective cohort studies. SETTING: Academic tertiary care emergency department (ED). PARTICIPANTS: 1,084 ED patients who were 65 years old or older. MEASUREMENTS: At the time of enrollment, trained research personnel performed the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation Sedation Score to determine delirium and level of arousal, respectively...
July 4, 2016: American Journal of Geriatric Psychiatry
Andrew H Ford
Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. Non-pharmacological approaches to prevention typically target multiple risk factors in a systematic manner (multicomponent interventions). There is generally good evidence that multicomponent interventions reduce the incidence of delirium in hospital populations but there are limited data in people with dementia and those living in the community...
October 2016: Maturitas
Martin G Cole, Jane McCusker, Robert Bailey, Michael Bonnycastle, Shek Fung, Antonio Ciampi, Eric Belzile
BACKGROUND: the implications of partial and no recovery from delirium after hospital discharge are not clear. We sought to explore whether partial and no recovery from delirium among recently discharged patients predicted increased adverse events (emergency room visits, hospitalisations, death) during the subsequent 3 months. METHOD: prospective study of recovery from delirium in older hospital inpatients. The Confusion Assessment Method was used to diagnose delirium in hospital and determine recovery status after discharge (T0)...
September 8, 2016: Age and Ageing
Marie Oxenbøll-Collet, Ingrid Egerod, Vibeke Christensen, Jeannette Jensen, Thordis Thomsen
BACKGROUND: Delirium in the intensive care unit (ICU) has received more attention in the past decade. Early detection, prevention and treatment of delirium are important, and the most commonly used tool for delirium assessment is the Confusion Assessment Method for the ICU (CAM-ICU). AIM: The aim of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. METHODS: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide...
September 5, 2016: Nursing in Critical Care
Catharina E van Ewijk, Gabriel E Jacobs, Armand R J Girbes
BACKGROUND: Delirium is a frequently occurring syndrome in patients admitted to the intensive care unit (ICU) or medium care unit (MCU), yet the pathophysiology remains poorly understood. An excess of central serotonin can lead to an altered mental status, associated with autonomic hyperactivity, and neuromuscular excitation. Drugs with serotonergic properties are frequently and for prolonged periods administered to ICU/MCU patients. Therefore, central serotonergic toxicity may constitute a predisposing, contributing or precipitating factor in the emergence of delirium...
December 2016: Annals of Intensive Care
Yiquan Lin, Ying Chen, Jingxia Huang, Hongbin Chen, Weihua Shen, Wenjun Guo, Qianru Chen, Hongfeng Ling, Xiaoliang Gan
STUDY OBJECTIVES: This study aimed to test the hypothesis that premedication with a single dose of intranasal dexmedetomidine (DEX) could not only reduce preoperative anxiety but also minimize the emergence agitation in children undergoing cataract surgery with sevoflurane anesthesia. DESIGN: Single-blinded, randomized, placebo-controlled clinical comparison study. SETTING: Academic medical center. PATIENTS: Ninety American Society of Anesthesiologists physical status 1 and 2 children scheduled for cataract surgery...
September 2016: Journal of Clinical Anesthesia
Guillaume Airagnes, Antoine Pelissolo, Mélanie Lavallée, Martine Flament, Frédéric Limosin
Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly...
October 2016: Current Psychiatry Reports
Kieran Anthony Walsh, Niamh A O'Regan, Stephen Byrne, John Browne, David J Meagher, Suzanne Timmons
BACKGROUND: Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia. METHODS: All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study...
August 16, 2016: International Psychogeriatrics
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