What is included in emergency department (ED) care of delirium, dementia, and amnesia?

Updated: Sep 19, 2018
  • Author: Richard D Shin, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

ED physicians caring for the patient with agitation, confusion, delirium, combativeness, or obtundation must ensure the safety of both the patient and the staff while attending to issues of airway protection and immediate recognition and treatment of rapidly reversible problems (eg, hypoxia, hypoglycemia, narcotic overdose).

Provide supplemental oxygen unless oxygen saturation is above 93% on room air.

When carbon monoxide poisoning is suspected, ignore the oxygen saturation, obtain a carboxyhemoglobin level, and provide 100% oxygen.

In cases of airway compromise, coma, or poor gag reflex, the ED physician should have a low threshold for intubation. Use rapid sequence intubation (RSI), particularly in the settings of possible head trauma, elevated ICP, or a combative patient. RSI/intubation may be necessary to facilitate imaging studies.

Treat suspected overdose-induced delirium based on ingestion history and/or toxidromes. Such treatment may range from simple observation and supportive care, activated charcoal, gastrointestinal lavage (rarely performed), sedation, specific antidotes to intoxication and life support.

The treatment of delirium is dependent on the identification of the underlying cause, which may not be elucidated during an ED stay. If patients remain delirious they should be admitted for further observation. 

Behavioral control of a patient with delirium who is agitated and combative should be primarily medication-based with physical restraining kept at a minimum and for protection of both the patient and staff (see Medication).


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