Coma, Confusion, and Agitation in Intensive Care
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Coma and delirium are very common in critically ill patients, and represent an independent risk factor for poor outcome.
Management of the comatose patient involves rapid initial assessment and correction of easily reversible causes, protecting the brain from further injury, diagnosing and specifically treating the underlying cause, plus good generic multidisciplinary care.
Management of delirium includes rapid assessment, treatment of easily reversible causes (pain, urinary retention, hypoxia, hypotension etc.) and investigation of other causes. Nonpharmacological measures are as important as drug therapy.
Guidelines (and adherence to them) are useful for both the assessment of delirium and monitoring of sedation scores.
The ideal sedative agent does not exist. Choice of agent(s) should be patient-specific, monitored closely to achieve the desired end-point with the minimum of side effects and given for the shortest time necessary.
Inappropriate use of sedatives may actually worsen or prolong delirium.
KeywordsGlasgow Coma Scale Alcohol Withdrawal Malignant Hyperthermia Comatose Patient Sixth Cranial Nerve Palsy
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