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レジデントノート

米国にて内科修行中。何ができるか模索している過程を記録していく

譫妄

検査

- Fingerstick Glucose

- Urine drug screen

- UA + Culture

- CBC/CMP

- Digoxin level PRN

- ABG

- EKG
- Chest portable X-ray

 

コンサルテーション

- psychiatry consult

- speech language consult

 

Medication

All Medications should be used only when non-pharmacologic interventions have failed and caution should be used when dosing these medications in the elderly

 

Caution:

* If QTc>450ms, highly recommend to discuss treatment options with psychiatry prior to ordering any medications below

* Please observe for the following: extrapyramidal symptoms

* If differential diagnosis is alcohol withdrawal or benzodiazepine withdrawal, initiate CIWA protocol

 

For hyperactive delirium with agitation, confusion, restlessness, sleep disturbance x 24 hours 

- Haloperidol 0.5/1mg PO Q2H PRN for hyperactive delirium

(total IV or PO maximum: not to exceed 10mg/24hours)

- Risperidone 0.5mg PO BID PRN for hyperactive delirium

- Quetiapine 12.5mg PO Q6H PRN for hyperactive delirium

 

For hyperactive delirium with combative behavior, spitting, throwing x 24 hours

- Haloperidol 2mg IV Q2H PRN for hyperactive delirium

(total IV or PO maximum: not to exceed 10mg/24hours)

- Risperidone 1mg PO BID PRN for hyperactive delirium

- Quetiapine 25mg PO Q6H PRN for hyperactive delirium

 

 (米国一施設基準)