Clarification Required: Question Does Not Match Available Evidence
The question asks whether a provider has made statements about patient derangement syndrome, which appears to be asking about documentation or communication practices. However, the evidence provided addresses clinical derangement syndromes (musculoskeletal conditions, altered mental status, and physiological derangements), not provider statements or documentation practices.
What the Evidence Actually Addresses
Musculoskeletal Derangement Syndrome
- McKenzie Mechanical Diagnosis and Therapy identifies derangement syndrome as a musculoskeletal classification where repetitive movements decrease symptoms and restore restricted range of motion, commonly applied to lumbar disc problems and temporomandibular joint disorders 1, 2, 3.
Physiological Derangement in Acute Care
- Physiological derangement refers to metabolic, electrolyte, or organ system dysfunction requiring urgent correction in critically ill patients, such as those undergoing emergency laparotomy or with liver dysfunction during COVID-19 4.
- Damage control surgery should be adopted in severely sick patients with physiological derangement, including severe electrolyte disturbances, coagulopathy, and hemodynamic instability 4.
Altered Mental Status Evaluation
- Altered mental status requires rapid assessment for metabolic factors, toxic ingestions, and neurologic causes, with immediate referral to emergency departments when primary care resources are insufficient 5.
- Delirium is a medical emergency with mortality twice as high when missed, requiring prompt identification using tools like the Confusion Assessment Method 4, 6.
If Your Question Is About Clinical Diagnosis
For musculoskeletal derangement syndrome: Diagnosis requires sustained loading tests and repeated movement assessment to identify directional preference, with follow-up sessions to confirm the initial classification by monitoring symptom changes 2, 3.
For physiological derangement: Immediate correction of electrolyte disturbances, hemodynamic optimization with goal-directed hemodynamic therapy (MAP 60-65 mmHg, Cardiac Index ≥2.2 L/min/m²), and glucose control in the range of 7.7-10 mmol/L are recommended 4.
For altered mental status/delirium: Point-of-care glucose testing, comprehensive metabolic panel, complete blood count, urinalysis, and non-contrast head CT when focal deficits or trauma are present 6, 4.
Please clarify whether you are asking about:
- Clinical diagnosis and management of derangement syndromes
- Provider documentation practices
- A specific type of derangement syndrome (musculoskeletal, metabolic, psychiatric)