Risk Factors for Delirium in Elderly Patients Visiting an Emergency Department

PURPOSE: Delirium is a common and worrisome problem among elder hospitalized patients. Many studies have sought to evaluate the risk factors of delirium. Most of these studies have dealt with the intensive care unit, with virtually nothing known about the emergency room. Our study was designated to evaluate the risk factors in an emergency department. METHODS: We retrospectively reviewed 414 cases of elder patients admitted to the general ward of internal medicine via the emergency room between January 2009 and December 2009. We divided these patients into a delirium group and non-delirium group. We statistically evaluated 31 known risk factors of delirium in these two groups. RESULTS: Using chi-square test, 14 of 31 known risk factors of delirium were proven as risk factors of delirium in an emergency room. Using logistic regression, three of the 14 proven risk factors were revealed as prior factors. CONCLUSION: A variety of factors of delirium are risk factors of delirium in an emergency room. A few important known risk factors are failed to pass statistically evaluation. These results are influenced by cultural pecularities of South Korea. Also, the small sample size limited conclusive evaluation. Nonetheless, the importance of patients' past medical history, laboratory results, and choice of medication when treating elder hospitalized patients to prevent delirium is likely important in reducing mortality and morbidity.

A Case of Carbon Dioxide Poisoning from Dry Ice Inhalation

Carbon dioxide (CO2) poisoning is rare, but its clinical features of acute exposure include cardiovascular, respiratory, neurologic and metabolic aspects. CO2 can also have a direct toxicological effect. At very high concentrations (>9%), CO2 induces respiratory depression and narcotic-like effects on the central nervous system. Especially, acute poisoning from dry ice is caused by CO2 gas inhalation and asphyxiation, and may impose excess load on the myocardium. This case was an acute CO2 poisoning from dry ice gas inhalation. In spite of an initial severe status, the male patient rapidly improved with no complications following the application of highly concentrated oxygen and fluid therapy.