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Diphenhydramine
18%
3/17
Lorazepam
35%
6/17
Olanzapine
24%
4/17
Phenobarbital
6%
1/17
Physical restraints
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This patient is presenting with delirium given his evening symptoms of aggression, agitation, and hallucinations in the setting of his elderly age and infection. An appropriate method of sedation is olanzapine. Delirium is a common problem in the inpatient setting, especially in elderly patients. Patients may present with agitation, aggression, hallucinations, paranoia, and irritability typically in the evening (termed sundowning). Besides behavioral interventions such as day-night regulation and re-orientation, medical therapies are sometimes needed. These are usually typical or atypical antipsychotics including haloperidol and olanzapine. Incorrect Answers: Answer 1: Diphenhydramine is an antihistamine with sedating properties. It is generally avoided in the elderly as it could worsen delirium. Answer 2: Lorazepam is a benzodiazepine which is also generally avoided in delirium as it could exacerbate symptoms of delirium. Answer 4: Phenobarbital is a barbiturate which is not typically used for sedation. It would be an appropriate initial treatment in alcohol withdrawal which presents with agitation, diaphoresis, and hypertension. Answer 5: Physical restraints are typically avoided in the elderly as they could worsen delirium and cause injury to the patient. They should be used if medications fail and the patient is putting others or themselves at risk. Bullet Summary: Antipsychotics such as haloperidol or olanzapine can be used initially in the management of delirium.
4.2
(11)
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