Rhode Island medical journal (2013)
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Recent studies have shown that the incidence of bloodstream infections (BSIs) associated with arterial catheters (ACs) is comparable to that of central venous catheters (CVCs). In 2011, the CDC published guidelines recommending the use of limited barrier precautions during AC insertion. The goal of this study was to assess the attitudes and current antiseptic techniques employed by physicians who place arterial catheters in intensive care units. ⋯ Use of barrier precautions for arterial catheter insertion was inconsistent in the cohort surveyed. Less than half of physicians surveyed were in compliance with CDC guidelines. Further studies are warranted to determine the optimal preventive strategies for reducing BSIs associated with ACs.
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Severe traumatic brain injury is associated with both acute and delayed neuro- logical injury. Cerebral vasospasm is commonly associated with delayed neurological decline in aneurysmal subarachnoid hemorrhage patients. However, the role played by vasospasm in traumatic brain injury is less clear. ⋯ We present a patient with a severe traumatic brain injury who had dramatic improvement following emergent decompressive hemicraniectomy. Two weeks after initial presentation he suffered a precipitous decline despite intensive surveillance. This case illustrates the distinct challenges of diagnosing cerebral vasospasm in the setting of severe traumatic brain injury.
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Delirium management begins with non-pharmacologic interventions and treatment of the underlying causes. There are no FDA-approved medications for delirium-related psychosis and agitation, although numerous agents have been studied. ⋯ Studies and expert guidelines support the use of antipsychotics for delirium-related psychosis and agitation, and demonstrate comparable efficacy and safety between first- and second- generation agents. Mounting evidence also suggests that antipsychotics and dexmedetomidine are effective in preventing delirium in surgical and mechanically- ventilated patients, respectively.
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Delirium is a highly prevalent and complex neuro- psychiatric disorder marked by attentional dysfunction, disturbances in multiple cognitive domains, and changes in motor behavior, perception, sleep, and thought process. Delirium results from diverse toxic, metabolic, infectious, and structural etiologies and is associated with a number of adverse outcomes. Delirium pathophysiology involves perturbation of multiple neurotransmitter systems. ⋯ Diagnostic assessment of delirium includes thorough physical examination, careful cognitive testing, appropriate metabolic and infectious studies, review of medications, and structural brain imaging and electroencephalography as indicated. Pharmacologic and non-pharmacologic interventions have been documented to reduce the incidence and severity of delirium. Anti- psychotics are the treatment of choice for delirium-related agitation and psychosis.