From Evidence to Practice: Managing Pain, Agitation and Delirium in the ICU

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Dr. Kim Medlej

Kamal (Kim) Medlej, MD, is an attending physician in the department of emergency medicine at Massachusetts General Hospital and fellowship-trained in critical care, and a longtime contributor to MDCalc. Here’s Dr. Medlej’s take on applying evidence on managing pain, agitation, and delirium to his patients in the ICU.

Pain, agitation, and delirium (the ICU triad) are common in critically ill patients, and can be challenging for clinicians to manage, both in (1) ruling out and treating potential underlying causes, and (2) choosing appropriate sedatives and analgesics in those patients who need them.

This is a fascinating area of critical care medicine, although it can also be difficult and frustrating. While our insight and screening tools have improved, the management of patients with pain, agitation, and/or delirium remains difficult. This is a large topic with a significant amount of literature and opinions. This brief overview is in no way comprehensive, but more a personal view, approach and practice.

Continue reading “From Evidence to Practice: Managing Pain, Agitation and Delirium in the ICU”

Centor’s Corner: FeverPAIN versus Centor Score

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Centor’s Corner

Editor’s note: Centor’s Corner is a new Paging MDCalc column featuring our favorite pharyngitis guru, blogger extraordinaire, and Scientific Advisory Board member Dr. Robert Centor, with regular insights from Dr. Centor on the applications of evidence to practice and musings from an experienced clinician. To comment on Centor’s Corner articles, please e-mail the editor at rachel@mdcalc.com or tweet directly to Dr. Centor @medrants.

On Twitter recently, several British tweeters discussed whether they should use the FeverPAIN Score or the Centor Score.  Obviously I have a bias here, but I will try to discuss this issue dispassionately.

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Interview with Dr. Ilene Claudius, Part 2 of 2: Pediatric Mass Casualty and Systemic Failures in Child Abuse

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Dr. Ilene Claudius

Can you tell us about your research in pediatric mass casualty incidents (MCI)? How did you develop an interest in pediatric mass casualty? Was there a particular patient experience that you had?

I haven’t had a personal experience with it, necessarily—we’ve certainly had some overwhelming car accidents, but nothing to the level that I would call a true pediatric mass casualty incident. These are always tragic events, and especially after Sandy Hook, it became clear that kids could make up a sizable portion if not the entirety of the victim population of an MCI.

We’ve done a lot of work in the PEM [pediatric emergency medicine] community on general community hospitals being ready to see a lot of kids in general. I work with an organization called COPEM [Committee on Pediatric Emergency Medicine] that looks at our pediatric receiving hospitals and makes sure they’re up to standard in terms of delivering pediatric care and having the appropriate supplies. And that’s just for a single routine pediatric patient. So the thought of how a group of very traumatized pediatric patients simultaneously is going to be handled is something we discuss a lot. Continue reading “Interview with Dr. Ilene Claudius, Part 2 of 2: Pediatric Mass Casualty and Systemic Failures in Child Abuse”

Interview with Dr. Ilene Claudius, Part 1 of 2: Managing Suspected Child Abuse in an Emergency Setting

dr-ilene-claudius

Dr. Ilene Claudius

Ilene Claudius, MD, is an associate professor of clinical emergency medicine and chief of pediatric emergency medicine at the Keck School of Medicine of the University of Southern California. She is editor-in-chief of Pediatric Emergency Medicine Practice, and her clinical research interests include pediatric mass casualty, non-accidental trauma (child abuse), and pediatric mental health.

Dr. Claudius has also studied apparent life-threatening events (ALTE) and brief resolved unexplained events (BRUE). She has authored or co-authored dozens of studies in peer-reviewed journals, and is an active contributor to the EM:RAP podcast. We talked to Dr. Claudius about her research and clinical expertise in pediatric emergency medicine.

Continue reading “Interview with Dr. Ilene Claudius, Part 1 of 2: Managing Suspected Child Abuse in an Emergency Setting”