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Hudak A, Sabini R, Moen M, Rothman D. Acute Management of Moderate to Severe Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:479-492. [PMID: 38945645 DOI: 10.1016/j.pmr.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The focus of this article is on the acute management of traumatic brain injury. The article focuses on the classification of traumatic brain injury, general acute management of traumatic brain injury, the role of the physiatrist on this team, and lastly, behavioral and family considerations in the acute care setting. The article includes a focus on physiologic systems, strategies for the management of various aspects of brain injury, and consideration of factors associated with the continuum of care. Overall, the article reviews this critical period of brain injury recovery and provides a primer for the physiatrist.
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Affiliation(s)
- Anne Hudak
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 223 E. Marshall Street Box 980677, Richmond, VA 23284-0667, USA; Central Virginia Veterans Affairs Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249-4915, USA
| | - Rosanna Sabini
- Department of Physical Medicine & Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, NY 11706, USA
| | - Makinna Moen
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 223 E. Marshall Street Box 980677, Richmond, VA 23284-0667, USA
| | - David Rothman
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 223 E. Marshall Street Box 980677, Richmond, VA 23284-0667, USA.
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Ferraz-Gonçalves JA, Silva AS, Reis JS, Assis JG, Matos MI, Matias P, Alves S. How are agitated patients dealt with in internal medicine departments? Porto Biomed J 2024; 9:260. [PMID: 38993951 PMCID: PMC11236411 DOI: 10.1097/j.pbj.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/13/2024] Open
Abstract
Background Studies on agitation in internal medicine departments are scarce, especially regarding how doctors and nurses act in these situations. The objective of this study was to clarify how agitation is dealt with in these departments. Methods This prospective observational study was performed in the internal medicine departments of four Portuguese hospitals. The researchers at each hospital contacted the nursing team that identifies patients who were agitated in the previous shifts. The researcher reviewed these patients' files, recording the research protocol's parameters. Results During the study period, 331 patients were observed; 177 (54%) were female, and the median age was 80 years (19-99). Episodes of agitation occurred in 69 patients (21%); of them, 44 (64%) were female, and the median age was 84 years (31-98). In the first episode of agitation, the doctor on duty was called in 49 times (71%). These doctors prescribed a new medication for the crisis in 30 cases (43%). After the crisis, the assistant doctor recorded the episode in the patient file in 41 cases (59%). According to the medical notes, after the acute phase, in only 21 patients (30%), there was an attempt to clarify the cause of agitation. The prescription after the crisis was regular medication in 32 cases (46%), rescue medication in 27 (39%), and physical restraint in 9 (13%), isolated or in various combinations. Conclusion This study suggests that there is room to improve how agitated patients are managed in internal medicine departments.
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Affiliation(s)
| | - Ana Sofia Silva
- Serviço de Medicina Interna, Unidade Local de Saúde Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Joana Silva Reis
- Serviço de Oncologia Médica, Unidade Local de Saúde São João, Porto, Portugal
| | - José Guilherme Assis
- Serviço de Medicina Interna, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Maria Inês Matos
- Serviço de Medicina Interna, Unidade Local de Saúde São João, Porto, Portugal
| | - Paula Matias
- Serviço de Medicina Interna, Unidade Local de Saúde São João, Porto, Portugal
| | - Sérgio Alves
- Serviço de Medicina Interna, Unidade Local de Saúde Nordeste, Bragança, Portugal
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Li X, Wang Y, Zhang Q. Effect of a physician-nurse integrated lung protection care model in neurocritical patients. Prev Med Rep 2024; 39:102637. [PMID: 38348217 PMCID: PMC10859279 DOI: 10.1016/j.pmedr.2024.102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
Background Lung injury resulting from diffuse pulmonary interstitial and other lung-related complications is a significant contributor to poor prognosis and mortality in patients with critical neurological diseases. To enhance patient outcomes, it is essential to investigate a lung protection model that involves the collaboration of doctors, nurses, and other medical professionals. Methods Patients receiving different care styles were divided into two groups: routine care (RC) and lung function protection care (LFPC). The LFPC group included airway and posture management, sedation and analgesia management, positive end-expiratory pressure titration in ventilation management, and fluid volume management, among others. Statistical analysis methods, such as chi-square, were used to compare the incidence of acute lung injury (ALI), neurogenic pulmonary edema (NPE), ventilator-associated pneumonia (VAP), acute respiratory distress syndrome (ARDS), and length of stay between the RC and LFPC groups. Results The RC group included 68 patients (33 males; 34-74 years of age). The LFPC group included 60 patients (29 males; 37-73 years of age). Compared with the RC group, the LFPC group had lower occurrence rates of ALI (20.0 % vs. 38.2 %, P = 0.024), NPE (8.3 % vs. 23.5 %, P = 0.021), VAP (8.3 % vs. 25.0 %, P = 0.013), and ARDS (1.7 % vs. 16.2 %, P = 0.015). The length of hospital stay was shorter in the LFPC group than in the RC group (11.3 ± 3.5 vs. 14.3 ± 4.4 days, P = 0.0001). Conclusion The physician-nurse integrated lung protection care model proved to be effective in improving outcomes, reducing complications, and shortening the hospital stay length for neurocritical patients.
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Affiliation(s)
- Xuan Li
- Neurosurgical Intensive Care Unit, Xijing Hospital, the Fourth Military Medical University, Xi 'an 710032, China
| | - Yu Wang
- Neurosurgical Intensive Care Unit, Xijing Hospital, the Fourth Military Medical University, Xi 'an 710032, China
| | - Qian Zhang
- Neurosurgical Intensive Care Unit, Xijing Hospital, the Fourth Military Medical University, Xi 'an 710032, China
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White G, Adessky N, Chen FW, Regazzoni A, Tourian L, Chagnon M, Gursahaney A, Alharbi M, Williamson D, Perreault MM. Valproic acid for agitation in the intensive care unit: an observational study of psychiatric consults. Int J Clin Pharm 2024; 46:177-185. [PMID: 38071694 DOI: 10.1007/s11096-023-01661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/09/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Agitation is a common clinical problem encountered in the intensive care unit (ICU). Treatment options are based on clinical experience and sparse quality literature. AIM The aim of this study was to describe the effect of valproic acid (VPA) as adjuvant treatment for agitation in the ICU, identify predictors of response to VPA and evaluate the independent effect of VPA on agitation compared to standard of care (SOC). METHOD This retrospective single center observational study evaluated adult patients admitted to the ICU for whom a psychiatric consultation was requested for agitation management, with agitation defined as a Richmond Agitation Sedation Score of 2 or greater. A descriptive analysis of the proportion of agitation-free patients per day of follow-up, the incidence of agitation-related-events, as well as the evolution of co-medications use over time are presented. A logistic regression model was used to assess predictors of VPA response, defined as being agitation-free on Day 7 and generalized estimating equations were used to evaluate the independent effect of VPA as adjuvant therapy for agitation in the critically ill. RESULTS One hundred seventy-five patients were included in the study with 78 receiving VPA. The percentage of agitation-free patients on VPA was 6.5% (5/77) on Day 1, 14.1% (11/78) on Day 3 and 39.5% (30/76) on Day 7. Multivariate regression model for clinical and demographic variables identified female gender as predictor of response on Day 7 (OR 6.10 [1.18-31.64], p = 0.03). The independent effect of VPA was non-significant when compared to SOC. CONCLUSION Although VPA used as adjuvant treatment was associated with a decrease in agitation, its effect when compared to SOC did not yield significant results.
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Affiliation(s)
- Geneviève White
- Department of Pharmacy, Réseau local de Gaspé, CISSS de la Gaspésie, 215 Boul York W, Gaspé, QC, G4X 2W2, Canada.
| | - Noah Adessky
- Department of Pharmacy, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
| | - Fei-Wen Chen
- Department of Pharmacy, CIUSSS Centre-Sud-de-l'île-de-Montréal, Hôpital Notre-Dame, 1560 Sherbrooke St E, Montreal, QC, H2L 4M1, Canada
| | - Anne Regazzoni
- Department of Pharmacy, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
| | - Leon Tourian
- Department of Psychiatry, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistic, University of Montreal, 2920 Chemin de la Tour, Montreal, QC, H3C 3J7, Canada
| | - Ashvini Gursahaney
- McGill University Health Centre, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
- Department of Medicine and Critical Care, McGill University, Montreal, Canada
| | - Majed Alharbi
- Department of Psychiatry, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
- Department of Adult Mental Health, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - David Williamson
- Department of Pharmacy and Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin West, Montreal, QC, H4J 1C5, Canada
- Faculté de Pharmacie, Université de Montréal, Pavillon Jean-Coutu, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Marc M Perreault
- Department of Pharmacy, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
- Faculté de Pharmacie, Université de Montréal, Pavillon Jean-Coutu, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
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Jafari H, Shafipour V, Kamali M, Mollaei A. Letter to the editor: 'Amiodarone-induced phlebitis: incidence and adherence to a clinical practice guideline'. Eur J Cardiovasc Nurs 2023; 22:e133-e134. [PMID: 37337657 DOI: 10.1093/eurjcn/zvad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- Hedayat Jafari
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vida Shafipour
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahsa Kamali
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirabbas Mollaei
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Critical Issues in the Management of Agitation, Aggression, and End-of-Life in Delusional Disorder: A Mini-Review. Healthcare (Basel) 2023; 11:healthcare11040458. [PMID: 36832992 PMCID: PMC9956049 DOI: 10.3390/healthcare11040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Background: Compared to other psychotic disorders, there is little information about staging care in delusional disorder (DD). Unlike schizophrenia, this is a disorder that begins in middle age, a time at which chronic medical comorbidities have already begun to impact global functioning. With age, the combination of psychological and somatic conditions leads to new behaviours, e.g., agitation, aggression, and behaviours that require specific preventive and interventive measures. With further age, knowledgeable end-of-life care becomes necessary for this population. Aim: The aim of this article was to review existing evidence on the management of these successive phases. Methods: We conducted a narrative review using PubMed and ClinicalTrials.gov and searched for the following terms: (agitation OR aggressivity OR aggression OR palliative OR "end-of-life") AND ("delusional disorder"). Results: We found that the literature was sparse. Existing evidence suggests that medical causes are frequently at the root of agitation and aggression. With respect to management, de-escalation strategies are generally preferred over pharmacotherapy. Specific delusional syndromes, e.g., de Clérambault, Othello, Capgras, Fregoli, as well as folie à deux, are associated with aggression. The somatic subtype of DD is the one most often requiring palliative care at the end of life. Conclusions: We conclude that insufficient attention has been given to the care needs of the accelerated aging process in DD.
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Liu GL, Wu GZ, Ge D, Zhou HJ, Cui S, Gao K, Sun WJ, Yu DH, Liu SB, Liu JJ. Efficacy and safety of ciprofol for agitation and delirium in the ICU: A multicenter, single-blind, 3-arm parallel randomized controlled trial study protocol. Front Med (Lausanne) 2023; 9:1024762. [PMID: 36698817 PMCID: PMC9868613 DOI: 10.3389/fmed.2022.1024762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background Agitation is very common in the intensive care unit (ICU). The causes include pain, delirium, underlying disease, withdrawal syndrome, and some drug treatments. The practical goal of ICU treatment is to find an appropriate sedation regimen to reduce pain, restlessness, and delirium. Previous trials have examined the use of dexmedetomidine, but no trials have evaluated the efficacy and safety of ciprofol, a new sedative drug. Methods This study was a multicenter, single-blind, 3-arm parallel randomized controlled trial. ICU patients aged ≥ 18 years with agitation and delirium who met the eligibility criteria were included. The main outcome was the proportion of patients who needed additional study medication or midazolam due to agitation within 4 h after the first intravenous injection of the study medication. The secondary outcomes included the pass rate as indicated by a Richmond Agitation-Sedation Scale (RASS) score < +1, the effectiveness rate of improving delirium symptoms, the number of recurrences of agitation within 24 h, the incidence of rescue treatment, the dose and cost of analgesic and sedative drugs, the length and cost of ICU stay, and the 30-day survival period. The safety evaluation included the incidence of adverse events (hypotension, bradycardia, hypoxia, etc.) and the rate of endotracheal intubation. The subjects were randomly assigned to receive ciprofol, dexmedetomidine, or normal saline at a ratio of 1:1:1. The rates of additional drug administration within 4 h after the first injection of the study drug in the three groups were 40, 50, and 90%, respectively. A total sample size of 81 subjects was required to reach 90% power and an α of 0.05. Considering a 20% loss rate, 102 patients were enrolled and randomly assigned to the three groups in equal proportions. Ethics and communication This trial was approved by the Ethics Committee of Dalian Municipal Central Hospital. The communication plan includes presentations at scientific conferences, scientific publications, and presentations to the public through non-professional media. Clinical trial registration www.ClinicalTrials.gov, identifier ChiCTR220006 2799.
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Affiliation(s)
- Guo Liang Liu
- Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Guo Zhi Wu
- Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Dong Ge
- Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Heng Jie Zhou
- Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Song Cui
- Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Kai Gao
- Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Wei Jia Sun
- Department of Pharmacy, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Dong Hai Yu
- Department of Anesthesiology, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Si Bo Liu
- Intensive Care Unit, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China,Intensive Care Unit, Beijing Friendship Hospital Affiliated Capital Medical University, Beijing, China,*Correspondence: Si Bo Liu,
| | - Jin Jie Liu
- Department of NO.2 General Medicine, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China,Neurological Intensive Care Unit, Beijing Tiantan Hospital Affiliated Capital Medical University, Beijing, China,Jin Jie Liu,
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Harorani M, Garshasbi M, Sediqi M, Farahani Z, Habibi D, Farahani M, Amini N, Velashjerdi Z. The effect of Shiatsu massage on agitation in mechanically ventilated patients: A randomized controlled trial. Heart Lung 2021; 50:893-897. [PMID: 34403892 DOI: 10.1016/j.hrtlng.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/14/2021] [Accepted: 07/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients admitted to the intensive care units encounter many complications due to the nature of the disease and invasive medical procedures such as intubation and mechanical ventilation. Among these complications, agitation is a frequently-observed and serious problem. OBJECTIVES This study aimed to investigate the effect of Shiatsu massage on agitation in mechanically ventilated patients. METHODS In this randomized controlled trial, a total of 68 mechanically ventilated patients were selected and then randomly assigned to two groups of intervention and control. Patients in the intervention group received three 5-minute periods of Shiatsu massage with a 2-minute break between them, while patients in the control group only received a touch on the area considered for the message. Data were collected before and after the intervention using the Richmond Agitation-Sedation Scale (RASS) and then analyzed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, N.Y., USA). RESULTS The results showed that the level of agitation significantly decreased in the intervention group compared to the control group (p=.001). CONCLUSION Application of shiatsu massage seems to be effective in managing agitation in mechanically ventilated patients. Further studies with greater sample size and longer follow-up period are needed to confirm the current findings.
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Affiliation(s)
- Mehdi Harorani
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran; Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.
| | - Masoumeh Garshasbi
- Student Research Committee, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Mohamad Sediqi
- Student Research Committee, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Zohreh Farahani
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Danial Habibi
- Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahtab Farahani
- Student Research Committee, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Nazanin Amini
- Department of paramedicine, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Velashjerdi
- Master of Nursing, Valiasr Arak Hospital, Arak University of Medical Sciences, Arak, Iran
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The Effects of Lavender and Citrus aurantium on Anxiety and Agitation of the Conscious Patients in Intensive Care Units: A Parallel Randomized Placebo-Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5565956. [PMID: 34222473 PMCID: PMC8219432 DOI: 10.1155/2021/5565956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
Background Conscious patients admitted to intensive care units (ICU) suffer from anxiety and agitation for various reasons, which can affect their recovery processes. Aims To compare the effects of lavender and Citrus aurantium essential oils on anxiety and agitation of conscious patients admitted to ICUs. Design A randomized parallel placebo-controlled trial. Methods One hundred and fifty conscious patients admitted to ICUs were selected by convenience sampling and were randomly divided into three groups, groups of lavender aromatherapy and Citrus aurantium aromatherapy, in addition to the routine care and inhalation of five drops of lavender or Citrus aurantium essential oils for 30 minutes. The placebo group, in addition to routine care, was provided with 5 drops of normal saline for 30 minutes. Anxiety was assessed with the state subscale of State-Trait Anxiety Inventory, and agitation was examined with Richmond Agitation-Sedation Scale before, immediately, one hour, and three hours after the intervention. Results All three groups suffered from relatively severe state anxiety before the intervention. The level of anxiety in the lavender and Citrus aurantium groups was significantly lower than that of the placebo group immediately and three hours after the intervention (P < 0.05). No significant difference was observed between the two groups of lavender and Citrus aurantium. The majority of the samples in all three groups were agitated before the intervention, but agitation of all three groups decreased after the intervention. Restless/agitation reduced significantly in all three groups. Although restless/agitation of the lavender and Citrus aurantium groups reduced more than that of the placebo, no significant difference was found between the three groups. Conclusion The results of the present study showed the positive effects of lavender aromatherapy and Citrus aurantium aromatherapy on reducing the anxiety of patients admitted to ICUs. Relevance to Clinical Practice. Aromatherapy can be used as an effective and safe intervention to reduce anxiety in ICUs.
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Late Presentation of Linezolid-Induced Serotonin Syndrome After Maprotiline and Mirtazapine Therapy: A Case Report. Clin Neuropharmacol 2021; 44:71-74. [PMID: 33443942 DOI: 10.1097/wnf.0000000000000431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This report describes a 45-year-old man who developed serotonin syndrome on day 13 of linezolid therapy. This is unusual as it typically appears within 24 hours of linezolid initiation. METHODS The patient did not receive any serotonergic agents concurrently with linezolid; maprotiline and mirtazapine were stopped 17 days before the development of serotonin syndrome. On day 13 of linezolid administration, the patient exhibited diaphoresis, fever, confusion, agitation, disorientation, anxiety, and restlessness. His blood pressure was elevated with persistent tachycardia. He was then diagnosed with serotonin syndrome using the Hunter criteria. RESULTS Linezolid was discontinued and supportive measures were initiated, which resulted in the complete resolution of the syndrome. CONCLUSIONS This case report highlights that linezolid-induced serotonin syndrome can occur late in the course of therapy and the importance of the serotonergic agent washout period before the introduction of linezolid. A multidisciplinary team is important for optimal diagnosis and management of such cases.
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Mulkey MA, Munro CL. Calming the Agitated Patient: Providing Strategies to Support Clinicians. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2021; 30:9-13. [PMID: 34092999 PMCID: PMC8171292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Agitation is a symptom of many medical and psychiatric disorders that can manifest along a spectrum of severity. Agitation often delays treatment onset, potentially impacting morbidity and mortality, and may require emergency interventions. Management of acute agitation centers around three main goals: early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel. Nurses should increase use of validated techniques, including frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life.
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Affiliation(s)
- Malissa A Mulkey
- UNC-REX Hospital, Raleigh, NC; and Post-Doctoral Research Fellow, Indiana University-Purdue University, Indianapolis, IN
| | - Cindy L Munro
- School of Nursing, Miami University, Coral Gables, FL
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