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Delirium in Emergency Department

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https://www.readbyqxmd.com/read/28927394/laboratory-markers-of-cardiac-and-metabolic-complications-after-generalized-tonic-clonic-seizures
#1
Robert D Nass, Sina Meiling, René P Andrié, Christian E Elger, Rainer Surges
BACKGROUND: Generalized tonic-clonic seizures (GTCS) frequently lead to emergency inpatient referrals. Laboratory blood values are routinely performed on admission to detect underlying causes and metabolic or cardiac complications. Our goal was to assess the nature and frequency of complications occurring in association with GTCS. METHODS: We retrospectively extracted data from emergency protocols and discharge letters of adult patients admitted to the Department of Epileptology between 01/2010 and 06/2015...
September 19, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28923236/emergency-nurses-knowledge-and-self-rated-practice-skills-when-caring-for-older-patients-in-the-emergency-department
#2
Helen Rawson, Paul N Bennett, Cherene Ockerby, Alison M Hutchinson, Julie Considine
BACKGROUND: Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses' knowledge and self-assessment of care for older patients is poorly understood. AIM: To assess emergency nurses' knowledge and self-rating of practice when caring for older patients. METHODS: A cross-sectional self-report survey of emergency nurses (n=101) in Melbourne, Australia...
September 8, 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/28887627/-sepsis-masquerading-as-delirium
#3
REVIEW
A Seifert, C S Hartog, J Zweigner, W Schummer, K Reinhart
A previously healthy 60-year-old patient presented to the emergency department with severe headache, altered personality and fever. He was treated for bacterial meningitis with delirium of unknown cause but presumed to be due to alcohol withdrawal. Despite receiving the antibiotic therapy regimen recommended for bacterial meningitis the patient's condition rapidly deteriorated with profound delirium and tachypnea. The intensivist who was consulted immediately suspected sepsis-associated organ failure and admitted the patient to the intensive care unit (ICU)...
September 8, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28862050/synthetic-cannabinoid-black-mamba-infidelity-in-patients-presenting-for-emergency-stabilization-in-colorado-a-p-scan-cohort
#4
Nicklaus Brandehoff, Axel Adams, Kyle McDaniel, Samuel D Banister, Roy Gerona, Andrew A Monte
BACKGROUND: Use of new psychoactive substances (NPS) has increased over the last decade. During this period, variability of both clinical presentations and chemical compositions of these compounds has increased. Synthetic cannabinoids (SCs) are the most commonly used NPS and there are more than 100 documented unique molecules in this class. "Black Mamba", often associated to ADB-FUBINACA, is the most commonly used SC in Colorado. It has been linked to kidney injury, myocardial toxicity, seizures, and death...
September 1, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28831910/delirium-in-advanced-cancer-may-have-link-to-lower-survival-rate
#5
(no author information available yet)
Patients with advanced cancer who present at emergency departments (EDs) with delirium are prone to an earlier death, a study has found.
August 23, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28822348/risk-factors-for-potential-drug-drug-interactions-in-intensive-care-unit-patients
#6
Slobodan M Janković, Ana V Pejčić, Miloš N Milosavljević, Valentina D Opančina, Nikola V Pešić, Tamara T Nedeljković, Goran M Babić
PURPOSE: To determine risk factors for each severity-based category of potential drug-drug interactions (DDIs) encountered at intensive care unit (ICU) patients. METHODS: This was a retrospective cohort analysis of patients treated at the ICU of the Clinical Center Kragujevac, a public tertiary care hospital in Kragujevac, Serbia. Three interaction checkers were used to reveal drug-drug interactions: Medscape, Epocrates and Micromedex. RESULTS: The study included 201 patients, 66...
August 14, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28765503/advance-directives-hospitalization-and-survival-among-advanced-cancer-patients-with-delirium-presenting-to-the-emergency-department-a-prospective-study
#7
Ahmed F Elsayem, Eduardo Bruera, Alan Valentine, Carla L Warneke, Geri L Wood, Sai-Ching J Yeung, Valda D Page, Julio Silvestre, Patricia A Brock, Knox H Todd
BACKGROUND: To improve the management of advanced cancer patients with delirium in an emergency department (ED) setting, we compared outcomes between patients with delirium positively diagnosed by both the Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS), or group A (n = 22); by the MDAS only, or group B (n = 22); and by neither CAM nor MDAS, or group C (n = 199). MATERIALS AND METHODS: In an oncologic ED, we assessed 243 randomly selected advanced cancer patients for delirium using the CAM and the MDAS and for presence of advance directives...
August 1, 2017: Oncologist
https://www.readbyqxmd.com/read/28743315/tight-intra-operative-blood-pressure-control-versus-standard-care-for-patients-undergoing-hip-fracture-repair-hip-fracture-intervention-study-for-prevention-of-hypotension-hip-hop-trial-study-protocol-for-a-randomised-controlled-trial
#8
Iain Keith Moppett, Stuart White, Richard Griffiths, Donal Buggy
BACKGROUND: Hypotension during anaesthesia for hip fracture surgery is common. Recent data suggest that there is an association between the lowest intra-operative blood pressure and mortality, even when adjusted for co-morbidities. This is consistent with data derived from the wider surgical population, where magnitude and duration of hypotension are associated with mortality and peri-operative complications. However, there are no trial to data to support more aggressive blood pressure control...
July 25, 2017: Trials
https://www.readbyqxmd.com/read/28741583/elderly-patients-with-an-atypical-presentation-of-illness-in-the-emergency-department
#9
M R Hofman, F van den Hanenberg, I N Sierevelt, C R Tulner
BACKGROUND: Very little information is available on the prevalence and clinical outcome of elderly patients with atypical presentations of illness in the emergency department. The objective was to determine the prevalence and clinical outcome of elderly patients seen in the emergency department with an atypical presentation. METHODS: A monocentric retrospective observational study on 355 elderly patients presenting to the emergency department. Patients of 80 years and older were included...
July 2017: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/28703024/safety-and-effectiveness-of-physostigmine-a-10-year-retrospective-review
#10
Ann M Arens, Krishna Shah, Suad Al-Abri, Kent R Olson, Tom Kearney
BACKGROUND: Physostigmine has long been recognized as an antidote to reverse anticholinergic delirium. However, its effectiveness, safety profile, and dosing have been disputed. OBJECTIVES: To describe effectiveness, adverse events, and dosing associated with the use of physostigmine to reverse anticholinergic delirium. METHODS: A retrospective cohort study of hospitalized patients reported to a regional poison center system between 2003 and 2012 who received physostigmine to reverse an anticholinergic toxidrome...
July 13, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28675451/rates-of-delirium-diagnosis-do-not-improve-with-emergency-risk-screening-results-of-the-emergency-department-delirium-initiative-trial
#11
Glenn Arendts, Jennefer Love, Yusuf Nagree, David Bruce, Malcolm Hare, Ian Dey
OBJECTIVES: To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults. DESIGN: Prospective trial with sequential introduction of screening and interventional processes. SETTING: Two tertiary referral hospitals in Australia. PARTICIPANTS: Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905)...
August 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28590990/delirium-upon-presentation-to-the-pediatric-emergency-department-a-case-series
#12
Julie A Augenstein, Eileen J Klein, Chani Traube
The following cases describe children who presented to the emergency department (ED) with a constellation of symptoms consistent with delirium. In each case, there was no identified inciting cause (eg, fever, medications) other than the presence of influenza. All children had variable workups, with 2 children undergoing extensive neurologic evaluation and testing. Clinical recognition of delirium in the pediatric acute care setting can be challenging, but heightened awareness by ED and primary care physicians may lead to earlier diagnosis, prevent unwarranted investigations, and decrease hospitalization...
June 6, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28571901/how-can-we-identify-patients-with-delirium-in-the-emergency-department-a-review-of-available-screening-and-diagnostic-tools
#13
Hidetaka Tamune, Daisuke Yasugi
Delirium is a widespread and serious but under-recognized problem. Increasing evidence argues that emergency health care providers need to assess the mental status of the patient as the "sixth vital sign". A simple, sensitive, time-efficient, and cost-effective tool is needed to identify delirium in patients in the emergency department (ED); however, a stand-alone measurement has not yet been established despite previous studies partly because the differential diagnosis of dementia and delirium superimposed on dementia (DSD) is too difficult to achieve using a single indicator...
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28559128/performance-of-the-modified-richmond-agitation-sedation-scale-in-identifying-delirium-in-older-emergency-department-patients
#14
Florian F Grossmann, Wolfgang Hasemann, Reto W Kressig, Roland Bingisser, Christian H Nickel
BACKGROUND: Delirium in older emergency department (ED) patients is associated with severe negative patient outcomes and its detection is challenging for ED clinicians. ED clinicians need easy tools for delirium detection. We aimed to test the performance criteria of the modified Richmond Agitation Sedation Scale (mRASS) in identifying delirium in older ED patients. METHODS: The mRASS was applied to a sample of consecutive ED patients aged 65 or older by specially trained nurses during an 11-day period in November 2015...
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28397128/characteristics-and-treatment-of-patients-with-clinical-illness-due-to-synthetic-cannabinoid-inhalation-reported-by-medical-toxicologists-a-toxic-database-study
#15
Andrew A Monte, Diane P Calello, Roy R Gerona, Eike Hamad, Sharan L Campleman, Jeffery Brent, Paul Wax, Robert G Carlson
INTRODUCTION: Synthetic cannabinoid (SC) abuse has resulted in numerous outbreaks of severe clinical illness across the United States over the past decade. The primary objective of this study was to determine the clinical characteristics of patients abusing SC requiring bedside consultation by medical toxicologists. METHODS: This was a multicenter analysis from a prospectively collected cohort of patients presenting to medical care after synthetic cannabinoid exposure, utilizing the ToxIC Registry...
June 2017: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/28396704/emergency-department-stay-associated-delirium-in-older-patients
#16
Marcel Émond, David Grenier, Jacques Morin, Debra Eagles, Valérie Boucher, Natalie Le Sage, Éric Mercier, Philippe Voyer, Jacques S Lee
BACKGROUND: Caring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium. METHODS: A historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay...
March 2017: Canadian Geriatrics Journal: CGJ
https://www.readbyqxmd.com/read/28338808/the-relationship-between-cognitive-impairment-mortality-and-discharge-characteristics-in-a-large-cohort-of-older-adults-with-unscheduled-admissions-to-an-acute-hospital-a-retrospective-observational-study
#17
Carole Fogg, Paul Meredith, Jackie Bridges, Gill P Gould, Peter Griffiths
Background: older people with dementia admitted to hospital for acute illness have higher mortality and longer hospital stays compared to those without dementia. Cognitive impairment (CI) is common in older people, and they may also be at increased risk of poor outcomes. Methods: retrospective observational study of unscheduled admissions aged ≥75 years. Admission characteristics, mortality rates and discharge outcomes were compared between three groups: (i) known dementia diagnosis (DD), (ii) CI but no diagnosis of dementia and (iii) no CI...
September 1, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28325154/the-behavioral-profile-of-methylenedioxypyrovalerone-mdpv-and-%C3%AE-pyrrolidinopentiophenone-pvp-a-systematic-review
#18
Cornel N Stanciu, Thomas M Penders, Samantha A Gnanasegaram, Elvin Pirapakaran, Juvraj S Padda, Jeeven S Padda
BACKGROUND: New psychoactive substances are emerging at an alarming rate. With novel structures and properties they produce unique behavioral characteristics during intoxication. Synthetic cathinones are some of the most common. More and more are presenting to emergency departments due to consequences of use. Aside from isolated reports, little is known about these compounds. OBJECTIVE: Here we review literature pertaining to two common synthetic cathinones, MDPV and alphaPVP, and correlate clinically with guidance on management of intoxications...
March 21, 2017: Current Drug Abuse Reviews
https://www.readbyqxmd.com/read/28263444/delirium-in-the-emergency-department-and-its-extension-into-hospitalization-delineate-study-effect-on-6-month-function-and-cognition
#19
Jin H Han, Eduard E Vasilevskis, Rameela Chandrasekhar, Xulei Liu, John F Schnelle, Robert S Dittus, E Wesley Ely
BACKGROUND: The natural course and clinical significance of delirium in the emergency department (ED) is unclear. OBJECTIVES: We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition. DESIGN: Prospective cohort study. SETTING: Tertiary care, academic medical center...
June 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28259697/antipsychotic-use-and-physical-morbidity-in-parkinson-disease
#20
Daniel Weintraub, Claire Chiang, Hyungjin Myra Kim, Jayne Wilkinson, Connie Marras, Barbara Stanislawski, Eugenia Mamikonyan, Helen C Kales
OBJECTIVE: To determine if antipsychotic (AP) use in Parkinson disease (PD) patients is associated with increased physical morbidity. METHODS: Veterans Health Administration data (1999-2010) was used to examine physical morbidity risk associated with AP use in idiopathic PD patients with stable recent physical health. We compared 180-day morbidity rates in patients initiating an AP with matched non-AP users who survived for 180 days (matched on age, sex, race, index year, presence and duration of dementia, PD duration, delirium, hospitalization, Charlson Comorbidity Index, and new non-psychiatric medications; covarying for psychosis)...
February 2, 2017: American Journal of Geriatric Psychiatry
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