Patient Restraint Protocol Medication Change

Transcription

1 Patient Restraint Protocol Medication Change

2 2015 2

3 Scope The Patient Restraint Protocol was changed from its previous state to allow the provider an expedient means of sedating a behavioral patient who is at significant risk to harm care providers and/or themselves

4 Background In early 2015, there was a marked uptick in synthetic cannabinoid use. As of May this year, 2,714 cases were reported to Poison Control Centers nationally. This drug was noted to have similar characteristics to Bath Salt (synthetic cathinones) use popular in and Spice/K2 (synthetic cannabinoids) in

5 Background These products contain dried, shredded plant material and chemical additives that are responsible for their psychoactive (mind-altering) effects

6 Background The Drug Enforcement Administration (DEA) has designated the five active chemicals most frequently found in Spice as Schedule I controlled substances, making it illegal to sell, buy, or possess them. Manufacturers have changed the chemicals and in 2015 this has returned under many other names but with similar effects

7 Delivery Method Most commonly smoked alone or mixed in marijuana. Sometimes seeped as a tea

8 Nearly twice as many male 12th graders reported past-year use of synthetic marijuana as females in the same age group

9 Effects Generalized effects of the drug include: Elevated mood Relaxation Altered perception In some cases, users reported psychotic effects like extreme anxiety, paranoia, and hallucinations

10 Effects Reported symptoms include: Tachycardia Vomiting Agitation Confusion Hallucinations Elevated blood pressure and reduced blood supply to the heart (myocardial ischemia)

11 Effects The hallmark of patients using these substances is the excited delirium that is often present. Symptoms include marked agitation and irrational behavior. Increased combative or aggressive actions. Dampened response to usual methods of sedation or restraint

12 Assessment of Patients for Restraint What is the patient s presentation before you approach? Is the patient visibly agitated or combative? Is it safe to approach the patient? Do you have an area of safe retreat? Is law enforcement needed to help safely approach the patient?

13 Assessment of Patients for Restraint Safety Aspects of Restraining a Patient Do you have enough personnel to safely restrain the patient? Do you have the correct restraints available to you? Have you used all other appropriate means to defuse or deescalate the situation?

14 Specific Decisions Regarding Synthetic Cannabinoids and Restraint Do you suspect synthetic cannabinoid use either by scene survey, history or assessment? Is the patient an adult and eligible under the protocol? Are there any other contraindications for sedation?

15 Specific Decisions Regarding Synthetic Cannabinoids and Restraint Due to the increased risks to patient and providers consideration needs to be given to the safest and most expedient manner of medication delivery. The recommended restraint is Midazolam 10 mg IM (intramuscular)

16 Specific Decisions Regarding Synthetic Cannabinoids and Restraint It is NOT recommended that IV access is obtained in these cases for initial medication administration. The increased risk of needle stick, exposure to blood or other substances and the risk of harm to those involved in restraint is severe when attempting IV access

17 Specific Decisions Regarding Synthetic Cannabinoids and Restraint Midazolam 10mg IN (intranasal) may be administered. While this access is relatively safe, it can have specific disadvantages. The combative and agitated patient may make it difficult to accurately administer the medications in this manner

18 Specific Decisions Regarding Synthetic Cannabinoids and Restraint Haloperidol is not to be used for restraint of patients suspected of synthetic cannabinoid use

19 In cases of existing IV access Midazolam 5mg IV may be given slow push generally over 1-2 minutes. Providers should be vigilant of the risk of hypotension as well as the presence of respiratory depression that can occur with IV Midazolam administration

20 Special Considerations As the second most abused substance among adolescents it is possible that a pediatric patient may require treatment. Contact Medical Control for orders appropriate for patient age and weight

21 Considerations Post Sedation Once chemical restraint is achieved appropriate physical restraint should be used in follow up. Routine medical care should be established once chemical restraint is achieved. The airway is paramount in ongoing assessment of the chemically restrained patient

22 Considerations Post Sedation You may additionally be able to monitor waveform capnography. Circulation, sensation and motion assessment of restrained extremities should be documented minimally every 15 minutes. Pulse oximetry may aid in this documentation

23 Deviation from Protocol Any deviation from protocol requires a medical control order. It is generally recommended that these communications happen on a recorded line

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