Page 50 - Critical Care Notes

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BASICS

Management of the Patient With Agitation or Delirium
■ Institute delirium protocol. Refer to: http://www.mc.vanderbilt.edu/icudelirium/
docs/Delirium_Protocol_2001_30_07.pdf
■ Monitor for delirium onset and resolution of symptoms.
Systematic use of standardized assessment tools should be used. Example:
All elderly patients should be screened with the CAM-ICU on ICU admission.
■ Provide a quiet and stable environment. Promote rest and control pain.
■ Provide reality orientation in any patient encounter.
■ Institute safety precautions. Physical restraints should be a last option.
■ Monitor VS and pulse oximetry. P/F ratio should improve in ARDS patients.
■ Monitor ECG.
■ Ensure adequate nutrition.
■ Provide progressive mobility exercise.
■ Monitor CBC, ESR, electrolytes, glucose levels, renal, liver and thyroid func-
tion tests, urinalysis, vitamin B 12 and thiamine levels, HIV status, urine and
blood toxicology, and ETOH levels.
■ CT, MRI, ECG, EEG, or CXR may be ordered to rule out physical courses of
delirium.
■ S-100 calcium-binding protein B (S100B) are seen in higher levels in
patients with delirium.
■ AACN recommends the ABCDE bundle (refer to Basics, Mechanical
Ventilation).
Medically Induced Coma
Also referred to as barbiturate coma.
Causes a temporary coma or a deep state of unconsciousness to protect the
brain from swelling and allow the brain to rest to help prevent brain damage.
Goal is to reduce ICP.
Medications used: propofol, pentobarbital, thiopental.
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