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The Confusion Assessment Method (CAM) is a diagnostic tool developed to allow physicians and nurses to identify delirium in the healthcare setting. [1] It was designed to be brief (less than 5 minutes to perform) and based on criteria from the third edition-revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R).
Delirium (formerly acute confusional state, an ambiguous term that is now discouraged) [1] is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or multiple causes, which usually develops over the course of hours to days.
The 4AT is designed to be used as a delirium detection tool in general clinical settings, inpatient hospital settings outside of the Intensive Care Unit (ICU), or in the community. The 4AT is intended to be used by healthcare practitioners without the need for special training, and it takes around two minutes to complete. [ 4 ]
After surgery, optimal pain management and infection control is important. Several studies have shown variable-significance positive effects when a multidisciplinary, multifactorial approach to elderly patient is followed during pre, peri and post-operative care. [5] [7]
The incidence of emergence delirium after halothane, isoflurane, sevoflurane or desflurane ranges from 2–55%. [10] Most emergence delirium in the literature describes agitated emergence. Unless a delirium detection tool is used, it is difficult to distinguish if the agitated emergence from anesthesia was from delirium or pain or fear, etc.
Psychiatric Intensive Care Units or PICUs are specialist twenty-four hour inpatient wards that provide intensive assessment and comprehensive treatment to individuals during the most acute phase of a serious mental illness. [1] [2] [3] Psychiatric intensive care is for patients who are in an acutely disturbed phase of a serious mental disorder.
To determine the depth of anesthesia, the anesthetist relies on a series of physical signs of the patient. In 1847, John Snow (1813–1858) [ 1 ] and Francis Plomley [ 2 ] attempted to describe various stages of general anesthesia, but Guedel in 1937 described a detailed system which was generally accepted.
A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate the patient. Chemical restraint is used in emergency, acute, and psychiatric settings to perform surgery or to reduce agitation, aggression or violent behaviours; [a] it may also be used to control or punish unruly behaviours. [2]