Background: Delirium is a common and costly occurrence in hospitalized patients, particularly elderly patients. Diagnosing delirium can be challenging, particularly given the fluctuating nature of presentation and subtle hypoactive motor subtypes. The Brief Confusion Assessment Method (bCAM) is a delirium screening tool that has been validated for use in the med-surg clinical area. As part […]

Background: Delirium is associated with increased morbidity, mortality and health care costs in the hospital setting secondary to increased length of stay and poor long term outcomes (1,2). A systematic review of different delirium prediction models found limitations with these models including derivation from small patient populations, lack of heterogeneity, accuracy and reliability as noted […]

Background: While delirium may affect patients of any age, delirium prevention and management protocols have focused mostly on the elderly, as older adults (>65 years old) are more vulnerable to developing delirium. Delirium has been reported in 19-31% of younger adults during their hospital stay, and 15-56% of older adults.There is lack of literature on […]

Background: While delirium may affect patients of any age, delirium initiatives have focused mostly on the elderly, as older patients are more vulnerable to developing delirium. Few studies have reported delirium in patients between 18-64 years of age, mostly restricted to patients with advanced cancer or on palliative care units. There is a lack of […]

Background: Delirium is a well know post-operative complication that has been shown to increase mortality, length of stay, and post-operative complications. Despite extensive study, there is limited treatment for delirium once it occurs. Emphasis on preventing delirium and identifying patients at risk is an important part of reducing its impact on the individual and the […]

Background: Severe alcohol withdrawal and delirium tremens (DTs) are challenging therapeutic dilemmas. To prevent complications and death, management requires close monitoring and intensive treatment, frequently in an ICU. Benzodiazepines are first line therapeutic agents, but optimal use and dosing has been limited, due to a lack of randomized double-blind trials. In lower acuity patients admitted […]

Background: Overnight disruptions in sleep during acute care hospitalizations contribute to lower patient satisfaction, higher risk of delirium, and potentially, increased length of stay. One primary offender of quality sleep is high frequency collection of vital signs during overnight hours. Protocols for reduction in collection of overnight vital signs have been successfully implemented at other […]

Case Presentation: As physicians, we frequently engage patients and families in goals of care discussions in the context of advanced serious illnesses. These discussions can be challenging for numerous reasons. We present an atypical case of a woman, who experienced acute onset of confusion, numbness, pre-syncope, chest pain, and abdominal pain, after initiating a discussion […]

Case Presentation: An 83-year-old woman presented as a transfer to our center for higher level of care in the setting of a mechanical fall with left femur fracture complicated by altered mental status (AMS) and acute onset atrial fibrillation (AF) with rapid ventricular response (RVR). A past medical history was significant for COPD, hypertension, hyperlipidemia, […]

Case Presentation: A 69-year-old woman presented for an elective multi-level lumbar laminotomy for the treatment of chronic back pain secondary to spinal canal stenosis. Her medical history included hypertension and hypercholesterolemia. She reported a history of depression, which was well controlled on paroxetine. She denied using drugs, stated she quit tobacco decades prior, and reported […]