Iatrogenic delirium and coma: a "near miss".
A 66-year-old woman was cared for at two referral institutions following a witnessed cardiac arrest in a local emergency department. Despite aggressive initial care, she failed to regain consciousness during a 28-day course. Based on an erroneous neurologic diagnosis of anoxic encephalopathy, pessimism regarding likelihood of improvement existed, prompting clinical consideration of withdrawal of care. The correct diagnosis of iatrogenic drug-induced coma alternating with drug-induced delirium only became apparent after the IV administration of repeated doses of a benzodiazepine antagonist. The patient and husband (co-authors) provide insights often unheard within care circles.
Dunn
William F
WF
Mayo Foundation, Rochester, MN 55905, USA. dunn.william@mayo.edu
Adams
Shirley C
SC
Adams
Robert W
RW
D000368:Aged; D003128:Coma / Q000139:chemically induced* / Q000175:diagnosis; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000601:surgery; D003693:Delirium / Q000139:chemically induced* / Q000175:diagnosis; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007049:Iatrogenic Disease; D008140:Lorazepam / Q000009:adverse effects*; D011182:Postoperative Care / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D006993:Hypnotics and Sedatives; D008140:Lorazepam