Acute behavioural disturbances

Question 1

if a paitent requires sedation or restraint what should be done?

Answer 1

provide sedation aiming for rousable drowsiness, apply and remove restraints as appropriate to the level of risk ath the time
provided sedation in accordence with their sat score

Question 2

what is the action for mild adgitation? SAT score of 1?

Answer 2

olanzapine oral
10mg repeated after 20 mins onces

or 5mg oral repated after 20 mins for elderly/frail or sedated from drugs or alcohol

Question 3

what is the treatemnt for moderate adgitation? sat score of 2?

Answer 3

Droperidol IM/IV 5-10mg repeat after 15minutes if required oor 5mg fro <60kgs/frail/elderly/sedation from drugs or alcohol- repeated after 15 once only

or Midazolam - Dripodol contra, lewie-body dementia or parkinsons

Midazolam if 2 driprodol is ineffective

Question 4

what are the midazolam doses?

Answer 4

IM
5-10 mg repeated after 10 once only
or 2.5-5mg if eldery/frail/<60kg, sedation from drugs/alcohol
repeate after 10 mins once only

IV
2.5-5mg - repeated at 5mins tirtrated to response
or
1-2mg <60kg, frail, sedation drugs/aclohol
repeated 5 mins titrated to response

Question 5

what is the max dose of midazolam?

Answer 5

20mg IM and IV
consult reciving hospital in suspected psychostimulant toxicity

Question 6

what are the ketamine doses?

Answer 6

IM
<60kg 200mg
60-90 kg 300mg
>90 400 mg

IV
50-100mg

Question 7

what is the action for sever agitation?

Answer 7

Ketamin IM/IV
consult reciving hospital
request MICA

Question 8

what is required for post sedation care?

Answer 8

monitor pt
reasses and manage clinical causes

Hyperthermic/increased muscle tone/seizure activity/alcohol withdrawl
Midazolam IM/IV - consult

If maitence of sedation required- olanzapine if cooperative, droperiodol IM/IV or Midazolam IM/IV if droperidol contraindicated

Question 9

when must you notify the hospital?

Answer 9

physically or mechanically restrained
escorted by police
current agitation SAT >0
current altered concious state SAT <0

Question 10

what are some potential causes for acute behavioural disturbances?

Answer 10

physical injury/pain (head injury)
acute medical condtion - hypoglyceic, post ictal
unmet needs - bladder distention, hunger, thirst, alcohol, nicotine withdrawl
substance abuse/poisioning
acute/uncontrolled mental health condition

Question 11

what suggests mild agitation?

Answer 11

able to cooperate and not agressive
anxious, pacing, restless, ecessive talking, hypervigalent, rapid shallow breathing, limited eye contact

Question 12

what suggests moderate agitation?

Answer 12

loud outbursts, frequent non-purposeful movments
not agressive or violent

Question 13

what is suggestive of sevre agitation?

Answer 13

combative, violent, immediate danger to pt/staff
unable to cooperate, yelling, verbally abusive

Question 14

if a pt has a traumatic head injury what are the sedation preferences?

Answer 14

sevre- can be managed with ketamine
mild/moderate - manage with judicious analgesia, the hypotensive effects of midazolam/droperidol, can be detramental to pt outcomes

Question 15

what is the goal of managing pshycostimulant toxicty and agitation in pts?

Answer 15

sevre- ketamine

ideally though benzodizapines should be used to decrease tempreture and muscle tone so midazolam should be used when safe to do so
small IV doses are stronly perfered.

balancing the risk for midazolam mangamgnet with airway/resp decreased and cardiovascular compromise.

Question 16

what must be done if physically restraining a paitent?

Answer 16

observing the whole time to ensure airway and breathing and circulation arent compromised
left lateral postion to avoid aspiration
do not restrain in the prone position

Question 17

what is the minimum standard of supportive care and monitoring after a SAT < -1 has been achived?

Answer 17

airway managment, supplmental O2, tempreture managment, reassesment and managment of clinical causes

Ketaime- managent of hypersalivation

montoring every 15 mins airway patencey, RR, HR, SPO2, contionuous cardiac monitoring, sedation tool assesment, neuro vascular obs, injury from restrained, blood pressure

Question 18

what are the SAT scores?

Answer 18

3 - responsivness: combative, violent, out of control
speech- continupous loud outbursts

2 very anxious/agitated
loud outbursts

1 anxious/restless normal /talative

0 awake but calm and cooperative speaks normal

• 1 asleep but rouses if name called slurring or prominent slowing

-2 respods to physical stimuli few recognizable words

• 3 no response to stimulation nill speach