Taming The SRU - December 22, 2015 - By Jon McKean
"We will all have the experience of taking care of a patient in the emergency department who is acting…different than they normally do. Sometimes, the change can be subtle, maybe a family member will be the first to notice and bring the patient to be evaluated. ..
WHAT CAN WE TAKE AWAY FROM ALL THIS?
- Delirium is common amongst elderly patients in the ED. A systematic review on the topic found most studies to find the occurrence to be about 10% in this population.
- We are bad at picking up on delirium. It is important to recognize that delirious patients are much more frequently of a hypoactive subtype and appear to be more depressed or catatonic than the more easily noticeable hyperactive subtype.
- It is important to get better at recognizing delirium given the significant implications to mortality. Early recognition may assist with further diagnostics if underlying pathology is not yet discovered, medical decision making to limit polypharmacy and exacerbating medications, as well as begin early management of delirium.
- Though the CAM-ICU has poor sensitivity overall, it has a better sensitivity than current emergency physician evaluation. Though not validated for universal screening, consider its application in the elderly patients that you evaluate in the emergency department who present with chief complaints other than AMS, especially if you get that feeling"
http://www.tamingthesru.com/blog/bread-and-butter/altered-states