ED management : the monthly update on emergency department management
-
While many older patients experience symptoms of delirium while in the emergency setting, the condition often is not recognized by emergency providers. Further, a missed diagnosis can lead to enhanced caregiver stress as well as a higher risk of institutionalization, readmission, and death. Experts suggest that providers need to be better educated on the subtle clues that a patient may be delirious so that steps can be taken to find and address the inciting cause. ⋯ Many patients with hypoactive delirium are mistaken as being depressed, and as a result, this is a subtype that is frequently missed by clinicians. While no screening tool is 100% effective, researchers have had the best success with a two-step process that involves use of a rapid Delirium Triage Screen (DTS) to rule out delirium. Patients who are not ruled out by the DTS then undergo a more formal Brief Confusion Assessment Method or B-CAM, a tool that is a modified form of the CAM-ICU.
-
With the outbreak of Ebola virus disease (EBD) accelerating in West Africa, public health authorities are urging frontline providers in the United States to be vigilant in questioning patients who present with a suspected infectious disease, and in adhering to infection control practices. Recent travel to West Africa and contact with others who may have been exposed to EVD are key points that need to be covered at triage, say experts. The World Health Organization (WHO) indicates that mortality from the latest outbreak is 55%, although it is as high as 75% in Guinea. ⋯ Experts say that one of the greatest times of risk for health care workers is while a patient is at triage because he or she has not yet been placed in isolation precautions. The CDC is recommending that hospitals rigorously apply standard infection control policies at a minimum, and that extra protective equipment may be required when there are body fluids in the patient environment. Hospitals in 27 states have reported dozens of suspected cases of EVD to the CDC, but at press time, none had yet tested positive.