Delirium in Emergency Department

INTRODUCTION: Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care. METHODS: We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist)...

STUDY OBJECTIVE: The emergency department (ED) poses unique challenges and risks to persons living with dementia. A longer ED length of stay is associated with the risk of death, delirium, and medication errors. We sought to determine whether ED length of stay differed by dementia status and trends in ED length of stay for persons living with dementia from 2014 to 2018 and whether persons living with dementia were at a higher risk for prolonged ED length of stay (defined as a length of stay > 90th percentile)...

We report the case of a male in his twenties who was prescribed 10 mg of zolpidem daily for sleep disturbances. Within one month, he self-augmented the dose to 30 mg daily. Unable to secure an authorized refill, he sought unauthorized suppliers and increased his daily intake to 70 mg over eight months. One day after his medication supply was depleted, he presented to the emergency department with symptoms indicative of acute delirium. Delirium was successfully alleviated within six hours using lorazepam. This was followed by a five-day lorazepam tapering regimen during the patient's hospital stay and then a subsequent four-day taper in an outpatient setting...

OBJECTIVES: The aim of this project was to improve compliance with evidence-based criteria regarding risk of delirium and the assessment of delirium among older patients in the general hospitalization wards and the emergency department. INTRODUCTION: More than 50% of older hospitalized patients experience delirium. Some studies have highlighted the need to implement an orientation protocol in the emergency department and to continue this in the general wards, with the aim of decreasing the delirium rate among older patients admitted to hospital...

Hyperactive delirium with severe agitation is a clinical syndrome of altered mental status, psychomotor agitation, and a hyperadrenergic state. The underlying pathophysiology is variable and often results from sympathomimetic abuse, psychiatric disease, sedative-hypnotic withdrawal, and metabolic derangement. Patients can go from a combative state to periarrest with little warning. Safety of the patient and of the medical providers is paramount and the emergency department should be prepared to manage these patients with adequate staffing, restraints, and pharmacologic sedatives...

BACKGROUND: Older adults are at an increased risk of postoperative morbidity. Numerous risk stratification tools exist, but effort and manpower are required. OBJECTIVE: This study aimed to develop a predictive model of postoperative adverse outcomes in older patients following general surgery with an open-source, patient-level prediction from the Observational Health Data Sciences and Informatics for internal and external validation. METHODS: We used the Observational Medical Outcomes Partnership common data model and machine learning algorithms...

BACKGROUND: The relationship between alcohol dependence and suicidal tendency is well recognized. Self-harm by cut throat is an uncommon but is potentially life-threatening when attempted. We present a description and discussion of a series of three cases of alcohol dependence syndrome who presented with self-inflicted cut throat wounds during the lockdown period from 24th March to 7th July 2020 due to the COVID-19 pandemic at the largest tertiary care hospital in Nepal. Case description ...

OBJECTIVE: Acute confusional syndrome (ACS) is one of the complications with the highest morbidity and mortality in hospitalization units, but it is a reversible situation if detected early, representing a clear challenge for nursing. The objectives of this study were to assess the interventions carried out by nurses for the identification and non-pharmacological preventive measures applied in acute confusional syndrome and relate them to the years of professional experience and training received...

BACKGROUND: The practice of safe emergency medicine requires accurate and adequate assessments. However, screening for cognitive deficits is not performed regularly in the emergency department (ED). This study aimed to determine factors influencing the frequency of cognitive testing by ED doctors. METHODS: This study included all doctors working in the EDs of three teaching hospitals. A 17-item online survey instrument that collected information on sex, experience, perceived prevalence, perception, and practice of cognitive assessment was distributed through electronic mail and data messaging services...

BACKGROUND: Altered mental status (AMS) in older adults is a common reason for admission to emergency departments (EDs) and usually results from delirium, stupor, or coma. It is important to proficiently identify underlying factors and anticipate clinical outcomes for those patients. AIM: The primary objective of this study was to reveal and compare the clinical outcomes and etiologic factors of older patients with delirium, stupor, and coma. The secondary objective was to identify the 30-day mortality risk for those patients...

Delirium is a common public health concern that significantly impacts older patients admitted to the Emergency Department (ED). This condition is linked to adverse outcomes such as reduced long-term functionality, higher mortality rates, extended hospital stays, and increased medical costs. The identification of risk factors is crucial for the early recognition and management of delirium in ED patients. Aging, cognitive decline, polypharmacy, and sensory impairment are some of the most common general risk factors described in the literature...

The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to the acute illness, while the current, or dynamic, component (3D+) assesses the multidimensional impact caused by the acute illness and helps to guide the choice of care facility for patients upon their discharge from the ED. The objective of this study was to evaluate the prognostic value of the 3D/3D+ to predict short- and long-term adverse outcomes in ED patients aged 75 years and older...

OBJECTIVE: To investigate the effect of improved nursing strategy on prognosis of older immunosuppressed patients with pneumonia and sepsis. METHODS: A prospective study was conducted. The older immunosuppressed patients with pneumonia and sepsis admitted to the department of intensive care medicine and emergency intensive care unit (ICU) of Peking Union Medical College Hospital from January 2017 to July 2022 were enrolled. In the first stage (from January 2017 to December 2019), patients received the original nursing strategy (original nursing strategy group), including: (1) nurses were randomly assigned; (2) routine terminal cleaning; (3) ICU environmental cleaning twice a day; (4) oral care was performed with chlorhexidine twice a day; (5) original lung physiotherapy [head of bed elevated at 30 degree angle-45 degree angle, maintaining a Richmond agitation-sedation scale (RASS) -2 to 1, sputum aspiration as needed]...

OBJECTIVE: To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. METHODS: A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled...

Cryptococcal meningitis is a life-threatening fungal infection of the central nervous system. It primarily affects immunocompromised individuals, particularly those with advanced HIV/AIDS, but can occur in people of all ages. Risk factors include solid organ transplantation, hematological malignancies, immunosuppressive medications, and primary immunodeficiency disorders. We describe a case of a 68-year-old male with atypical risk factors for cryptococcal meningitis who presented acutely delirious with a negative diagnostic workup aside from a positive cerebrospinal fluid (CSF) meningitis screen reporting Cryptococcus neoformans/gattii...

To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group...

In this segment of the emergency department (ED) palliative care case series, we present a patient who arrives to the ED after a fall resulting in a hip fracture. He is also found to have hypernatremia and an acute kidney injury and develops delirium while in the ED awaiting an inpatient bed. The ED-based integrated geriatric palliative care program is consulted and performs a multidimensional assessment. The geriatric palliative care clinician facilitates discussion with his daughter about surgical intervention based on the patient's goals and values, diagnoses delirium, and worsening depression, creates a plan for delirium and pain management, and accelerates postdischarge planning...

INTRODUCTION: Agitation management in delirious patients is crucial in a crowded emergency department (ED) for both patient and personnel safety. Benzodiazepines, antipsychotics, and newly derived ketamine are among the most commonly used drugs in controlling these cases. This study aimed to compare the effectiveness of haloperidol-midazolam with haloperidol-ketamine combination in this regard. METHODS: In this double-blind randomized clinical trial, delirious patients with agitation in ED were randomly assigned to a group: group A: haloperidol 2...

IMPORTANCE: Cefepime and piperacillin-tazobactam are commonly administered to hospitalized adults for empirical treatment of infection. Although piperacillin-tazobactam has been hypothesized to cause acute kidney injury and cefepime has been hypothesized to cause neurological dysfunction, their comparative safety has not been evaluated in a randomized clinical trial. OBJECTIVE: To determine whether the choice between cefepime and piperacillin-tazobactam affects the risks of acute kidney injury or neurological dysfunction...

PURPOSE: The number of visits to the emergency department (ED) is growing among older patients. Older people are at risk of acute delirium, which is associated with mortality. Our primary objective was to determine the 30-day mortality outcome between older patients with and without acute delirium. METHODS: From August 2018 to October 2019, we conducted a prospective cohort study in the ED of a tertiary care and university hospital. Patients over the age of 65 years who presented to the ED were included in the study...