Sedation and Delirium in the ICU

Source: N Engl J Med 2014;370:444-54.

Definition of delirium (DSM-IV)

Four domains of delirium: disturbance of consciousness, change in cognition, development over a short period, and fluctuation.

Definition of delirium (NIH)
Sudden severe confusion and rapid changes in brain function that occur with physical or mental illness.

Medications and Assessment

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專科護理師私塾

第五期以後 (2014-2016) 專科護理師培訓 -- 走過的足跡 ~~

課程大綱依據
  台灣專科護理師學會規範
    (左下選單) 專科護理師專區 --> 培訓醫院及訓練規章
     --> 用 "課程" 關鍵字搜尋
  美國專科護理師學會標準 (Am Assoc of Nurse Practitioners)

首部曲：臨床決策與鑑別診斷
  焦點式病史訪談及記錄
    醫療記錄的要求及格式範本指引
  病史詢問一般原則
  結構化病史詢問
  身體評估
  臨床決策與鑑別診斷 講義
    參考文獻：Collecting and Analyzing Data
  診斷工具的正確性
  選擇適當的治療 - 實證醫療原則
    初學者請參考：實證醫學百寶箱


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口訣集注

Mnemonic Collections

Altered Mental Status – AEIOU TIPS

• A – Alcohol
• E – Endocrine, Electrolytes, Encephalopathy
• I – Insulin (high or low BS)
• O – Oxygenation, Overdose (Opiates, hypnOtics)
• U – Uremia
• T – Trauma
• I – Infection
• P – Poisoning, Psychiatric
• S – Stroke (infarct or hemorrhage), Seizure, Shock

Acute Abdomen – BIOPI

• B – Bleeding or hemorrhage: AAA, HCC or spleen rupture/ peptic ulcer bleeding
• I – Ischemia or infarct: ischemia bowel/ renal infarct
• O – Obstruction: intestinal obstruction/ biliary or ureteral stone obstruction
• P – Perforation: perforated peptic ulcer/ hollow organ perforation
• I – Infection or inflammation: hepatobiliary tract infection, appendicitis, diverticulitis, pancreatitis

Focus Fever Survey in the ED – LOUIS

• L – Lung infections: URI related history taking and PE
• O – others
• U – Urinary tract infections: UTI, APN
• I – Intra-abdominal infections or abscess: hepatobiliary, appendicitis, diverticulitis, colitis...
• S – Soft tissue infections: decubitus ulcers or bedsores, cellulitis, fasciitis

Brain CT Reading Mnemonic – Blood Can Be Very Bad

• B – Blood
• C – 4 key Cisterns
• B – Brain Parenchyma
• V – Ventricles
• B – Bony Skulls

另有 High Anion Gap Metabolic Acidosis (連結)

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