An increasing number of elderly patients are presenting to the emergency department. Numerous studies have observed that emergency physicians often fail to identify and diagnose delirium in the elderly. These studies also suggest that even when emergency physicians recognized delirium, they still may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation of aging and, often, is the only sign of a serious underlying medical condition. This article will review the significance, definition, and principal features of delirium so that emergency physicians may better appreciate, recognize, evaluate, and manage delirium in the elderly. [West J Emerg Med.2012;13(2):194–201.]

จำนวนผู้สูงอายุที่มารับบริการในห้องฉุกเฉินมีปริมาณเพิ่มขึ้นเรื่อยๆ หลายการศึกษาพบว่าแพทย์เวชศาสตร์ฉุกเฉินมักไม่ค่อยคำนึงถึงและให้การวินิจฉัยผิดพลาดในภาวะซึมสับสนเฉียบพลันของผู้สูงอายุได้บ่อย  รวมทั้งยังไม่เข้าใจการดูแลรักษาโรคนี้อย่างถ่องแท้  ภาวะนี้ไม่ใช่เกิดจากความชรา และบ่อยครั้งกลับกลายเป็นอาการนำของโรคร้ายแรงบางโรคได้  บทความนี้จะทำการทบทวนความสำคัญของโรค คำจำกัดความ ลักษณะของโรคเพื่อให้แพทย์เวชศาสตร์ฉุกเฉินเข้าใจโรคได้ดีขึ้นทั้งในการวินิจฉัย ประเมินและให้การรักษาได้อย่างเหมาะสม

 [West J Emerg Med.2012;13(2):194–201.]

[West J Emerg Med. 2009;10(4):303]

Background: Over the past 15 years, violent threats and acts against hospital patients, staff, and providers have increased and escalated. The leading area for violence is the emergency department given its 24/7 operations, its role in patient care, admissions gateway, and the center for influxes during acute surge events.

Objectives: This investigation had three objectives: to assess the current security of Washington State EDs, to estimate the prevalence of and response to threats and violence in Washington State EDs, and to appraise the Washington State ED security capability to respond to acute influxes of patients, bystanders, and media during acute surge events.

Methods: A voluntary, blinded, 28-question web-based survey developed by ED physicians was electronically delivered to all 87 Washington State ED Directors in January 2013. Responses were evaluated by descriptive statistical analyses.

Results: Analyses occurred after 90% (78/87) of ED Directors responded. Annual censes of the EDs ranged from < 20,000 to 100,000 patients and represented the entire spectrum of practice environments, including critical access hospitals to a regional quaternary referral medical center. Thirty-four of 75 (45%) reported the current level of security was inadequate based on the general consensus of their ED staff. Nearly two-thirds (63%) of EDs had 24-hour security personnel coverage, 28% reported no assigned security personnel. Security personnel training was provided by 45% of hospitals or health care systems. Sixty-nine of 78 (88%) respondents witnessed or heard violent threats or acts occurring in their ED. Of these, 93% were directed towards nursing staff, 90% towards physicians, 74% towards security personnel, and 51% towards administrative personnel. Nearly half (48%) noted incidents directed towards another patient, and 50% towards a patient’s family or friend. These events were variably reported to the hospital administration. After an acute surge event, 35% believed the initial additional security response would not be adequate and 26% reporting no additional security would be available within 15 minutes.

Conclusion: Our study reveals the variability of ED security staffing and a heterogeneity of capabilities throughout Washington State. These deficiencies and vulnerabilities are likely shared by and relevant for other EDs and regional emergency preparedness planners.