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Delirium in Emergency Department

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https://www.readbyqxmd.com/read/27882039/pediatric-tooth-extractions-under-sedoanalgesia
#1
Ayse Hande Arpaci, Berrin Isik
OBJECTIVE: The present study aims to evaluate intravenous ketamine and inhalation sedation in children, their unwanted side-effects and surgeon satisfaction. METHODS: In this study, data of 922 children aged between 1-18 who underwent tooth extraction under sedoanalgesia in our department between September 2015-January 2016 were gathered and anesthesia approaches, unwanted side effects and surgical satisfaction was investigated. Postoperative recovery emergence agitation or delirium was evaluated with Watcha Behavior Scale (WBS)...
September 2016: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/27881092/the-relationship-between-in-hospital-location-and-outcomes-of-care-in-patients-diagnosed-with-dementia-and-or-delirium-diagnoses-analysis-of-patient-journey
#2
Lua Perimal-Lewis, Clare Bradley, Paul H Hakendorf, Craig Whitehead, Louise Heuzenroeder, Maria Crotty
BACKGROUND: The discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted to hospital can be placed in units or wards other than that which specialise in the patient's primary health issue (home-ward). These patients are called 'outlier' patients. Risk factors and health system outcomes of hospital care for 'outlier' patients diagnosed with dementia and/or delirium are unknown. Therefore, the aim of this research was to examine patient journeys of people with dementia and/or delirium diagnoses, to identify risk factors for 'inlier' or 'outlier' status and patient or health system outcomes (consequences) of this status...
November 24, 2016: BMC Geriatrics
https://www.readbyqxmd.com/read/27872590/test-retest-reliability-of-a-serious-game-for-delirium-screening-in-the-emergency-department
#3
Tiffany Tong, Mark Chignell, Mary C Tierney, Jacques S Lee
Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. Failure to recognize delirium can have devastating consequences including increased mortality (Kakuma et al...
2016: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/27765479/etiologies-and-delirium-rates-of-elderly-ed-patients-with-acutely-altered-mental-status-a-multicenter-prospective-study
#4
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
https://www.readbyqxmd.com/read/27747731/status-epilepticus-and-delirium-associated-with-ertapenem-in-a-very-elderly-patient-with-chronic-kidney-disease-and-silent-ischaemic-cerebrovascular-disease
#5
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
https://www.readbyqxmd.com/read/27685422/a-systematic-review-of-observational-pain-assessment-instruments-for-use-with-nonverbal-intubated-critically-ill-adult-patients-in-the-emergency-department-an-assessment-of-their-suitability-and-psychometric-properties
#6
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
https://www.readbyqxmd.com/read/27677382/improving-ghb-withdrawal-with-baclofen-study-protocol-for-a-feasibility-study-for-a-randomised-controlled-trial
#7
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
https://www.readbyqxmd.com/read/27651501/bet-1-screening-for-delirium-within-the-emergency-department
#8
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
https://www.readbyqxmd.com/read/27641565/a-e-fails-to-detect-delirium-in-advanced-cancer-patients
#9
(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
https://www.readbyqxmd.com/read/27624508/acute-porphyria-presenting-as-major-trauma-case-report-and-literature-review
#10
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...
November 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27623552/exploring-delirium-s-heterogeneity-association-between-arousal-subtypes-at-initial-presentation-and-6-month-mortality-in-older-emergency-department-patients
#11
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
https://www.readbyqxmd.com/read/27517801/prehospital-ketamine-is-a-safe-and-effective-treatment-for-excited-delirium-in-a-community-hospital-based-ems-system
#12
Thomas R Scaggs, David M Glass, Megan Gleason Hutchcraft, William B Weir
Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics)...
October 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/27491700/adverse-events-related-to-the-new-psychoactive-substance-3-fluorophenmetrazine-results-from-the-swedish-strida-project
#13
Matilda Bäckberg, Jenny Westerbergh, Olof Beck, Anders Helander
BACKGROUND: New psychoactive substances (NPS) are often poorly pharmacologically documented and the production is unregulated, implying high risks for toxic side effects. This report from the STRIDA project describes analytically confirmed non-fatal intoxications involving the phenmetrazine analogue 3-fluorophenmetrazine (3-FPM). STUDY DESIGN AND METHODS: Observational case series of patients with suspected acute NPS exposure requiring hospital care. Blood and urine samples were collected from patients presenting in emergency departments (ED) or intensive care units (ICU), after consultation with the Swedish Poisons Information Centre (PIC)...
November 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27475019/altered-mental-status-and-delirium
#14
REVIEW
Scott T Wilber, Jason E Ondrejka
Older patients who present to the emergency department frequently have acute or chronic alterations of their mental status, including their level of consciousness and cognition. Recognizing both acute and chronic changes in cognition are important for emergency physicians. Delirium is an acute change in attention, awareness, and cognition. Numerous life-threatening conditions can cause delirium; therefore, prompt recognition and treatment are critical. The authors discuss an organized approach that can lead to a prompt diagnosis within the time constraints of the emergency department...
August 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27475008/current-trends-in-geriatric-emergency-medicine
#15
REVIEW
Joseph H Kahn, Brendan G Magauran, Jonathan S Olshaker, Kalpana N Shankar
The number of geriatric visits to United States emergency departments continues to rise. This article reviews demographics, statistics, and future projections in geriatric emergency medicine. Included are discussions of US health care spending, geriatric emergency departments, prehospital care, frailty of geriatric patients, delirium, geriatric trauma, geriatric screening and prediction tools, medication safety, long-term care, and palliative care.
August 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27459411/the-geriatric-day-hospital-preliminary-data-on-an-innovative-model-of-care-in-brazil-for-older-adults-at-risk-of-hospitalization
#16
Márlon J R Aliberti, Claudia K Suemoto, Sileno Q Fortes-Filho, Juliana A Melo, Carolina B Trindade, Juliana Y T Kasai, Marcelo Altona, Daniel Apolinario, Wilson Jacob-Filho
Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting...
October 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27455035/delirium-frequency-among-advanced-cancer-patients-presenting-to-an-emergency-department-a-prospective-randomized-observational-study
#17
Ahmed F Elsayem, Eduardo Bruera, Alan D Valentine, Carla L Warneke, Sai-Ching J Yeung, Valda D Page, Geri L Wood, Julio Silvestre, Holly M Holmes, Patricia A Brock, Knox H Todd
BACKGROUND: The frequency of delirium among patients with cancer presenting to the emergency department (ED) is unknown. The purpose of this study was to determine delirium frequency and recognition by ED physicians among patients with advanced cancer presenting to the ED of The University of Texas MD Anderson Cancer Center. METHODS: The study population was a random sample of English-speaking patients with advanced cancer who presented to the ED and met the study criteria...
September 15, 2016: Cancer
https://www.readbyqxmd.com/read/27454857/cancer-patients-with-delirium-in-the-emergency-department-a-frequent-and-distressing-problem-that-calls-for-better-assessment
#18
EDITORIAL
Peter G Lawlor
No abstract text is available yet for this article.
September 15, 2016: Cancer
https://www.readbyqxmd.com/read/27347070/case-report-an-adult-onset-type-ii-citrin-deficiency-patient-in-the-emergency-department
#19
Lujia Tang, Liang Chen, Hairong Wang, Lihua Dai, Shuming Pan
Mutations in the solute carrier family 25 (SLC25A13) gene may result in neonatal intrahepatic cholestasis caused by citrin deficiency and/or adult-onset type II citrullinemia. These conditions are inherited in an autosomal recessive manner. The current case report describes a 43-year-old man who presented with sudden delirium and upper limb weakness. Upon admission, the patient was fully conscious and alert but later lost consciousness subsequent to a sudden convulsive seizure. Hyperammonemia was detected and analysis of the SLC25A13 gene identified an 851del4 mutation...
July 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27346621/detecting-delirium-superimposed-on-dementia-evaluation-of-the-diagnostic-performance-of-the-richmond-agitation-and-sedation-scale
#20
Alessandro Morandi, Jin H Han, David Meagher, Eduard Vasilevskis, Joaquim Cerejeira, Wolfgang Hasemann, Alasdair M J MacLullich, Giorgio Annoni, Marco Trabucchi, Giuseppe Bellelli
OBJECTIVES: Delirium disproportionately affects patients with dementia and is associated with adverse outcomes. The diagnosis of delirium superimposed on dementia (DSD), however, can be challenging due to several factors, including the absence of caregivers or the severity of preexisting cognitive impairment. Altered level of consciousness has been advocated as a possible useful indicator of delirium in this population. Here we evaluated the performance of the Richmond Agitation and Sedation Scale (RASS) and the modified-RASS (m-RASS), an ultra-brief measure of the level of consciousness, in the diagnosis of DSD...
September 1, 2016: Journal of the American Medical Directors Association
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