Aust N Z J Psychiatry. Intravenous sedation of involuntary psychiatric patients is practised in almost all hospitals in New South Wales. Despite its widespread use, little has been published about the medications used or their safety and efficacy.
This specialised patient group presents a huge challenge to both the flight crew and our remote colleagues when presenting acutely unwell in our communities.
Sedating a psych patient alien thought maybe we had a few psychiatric patients but I quickly realised after my presentation that the number of psychiatric retrievals we undertake in the top end is well above average i. Demographically the patient population remains consistent with approx. The mean age is 31, however our youngest was 12, our oldest being 74 patifnt. The inpatient psychiatric ward at Pstch has a catchment area singlebörsen kostenlos und ohne anmeldungsquare kilometres.
Mental illness throughout the world is on the increase with the WHO predicting mental illness to be second only to cardiovascular disease for burden of disease by The stigma associated with mental health issues remains the greatest obstacle to such patients accessing appropriate care. This stigma may be even more pronounced in remote Indigenous communities. I quickly realised then that CareFlight and other retrieval services working in truly remote areas provide a unique service.
We all know too well the challenges involved in the aeromedical transport of compliant patients who are unwell. However if we add delusions, hallucinations, physical aggression a tendency to physical violence and homicidal thoughts into the mix we have a potential aviation disaster on our hands. These are aliwn just some of the symptoms the majority of our psychiatric patients display when referred to CareFlight. We then face the task of transporting such patients in a small aircraft where we will place seatbelts and wrist and ankle restraints on them, we will sit approximately 50cm away from them and the tell them Pztient cannot smoke, they cannot go to the bathroom, they cannot eat or drink.
The biggest challenge for the aeromedical clinician is assessing the need and amount of sedation that will be required for safe retrieval of the acute psychiatric patient.
However we have found that pre-flight sedation Sedating a psych patient alien an atypical antipsychotic olanzapine and a sedative diazepam is of the utmost importance. This enables the psychiatric patient to be admitted to the appropriate ward in a timely manner. As mentioned above, premedication prior to retrieval is vitally important. In most cases Sedating a psych patient alien antipsychotic Olanzapine 10mg and a benzodiazepine Diazepam 10mg is the premedication of choice.
However, acute psychiatric patients presenting with drug induced psychosis be it first or subsequent presentations patinet require up to 20mg- 30mg of both Olanzapine and Diazepam orally. If the patient is not responding to the Olanzapine and Diazepam, the likelihood of requiring in-flight sedation is increased Sedating a psych patient alien is the probability of intubation for transport.
We find in flight we tend to use midazolam, propofol and ketamine. On arrival at the referral centre the patients are assessed for the need Sedating a psych patient alien further sedation prior to flight. The ability to patieng the sedative and allow the patient to wake prior to Sedating a psych patient alien at the receiving centre is extremely important. Richmond Agitation Sedation Scale: Managing the stressors of flight is extremely important when retrieving an acute psychiatric Sedating a psych patient alien.
Using ear plugs, blankets to keep patients warm, positioning for comfort when heavily sedated, limiting cabin conversation and ensuring physical restraint are fastened appropriately ensures the Sedating a psych patient alien psychiatric patient does not experience any extraneous stressors throughout their psyxh. On occasion the local law enforcement will be involved with the acute psychiatric retrieval.
The resource poor environment of the community clinic necessitates the presence of police to help control patients as documented under the section 9.
The coordinating Medical Sedating a psych patient alien Consultant will liaise with the Consultant Psychiatrist on Sedating a psych patient alien at the hospital, alerting them to the impending admission. Although the collective groan wohlhabender mann sucht junge frau another psychiatric retrieval arises resonates through the base we remain steadfast in our support Sedating a psych patient alien our rural and remote colleagues and we will continue to play a vital role in maintaining safety of the community, the families and the patients who are all touched by mental illness in the top end of the NT.
Keep up the good work at the Top End retrieval. Time to publish your results formally on ketamine! Like Liked by 1 person. Secondly — great article on psych Die besten online dating seiten deutschland Please note. Kudos on you for this work on psych transfer. I will see ppatient can dig it out…. The common areas in care from different organisations are a lot bigger than the not common bits.
And really like the matrix approach. Thanks for your comments. I agree that although acute psychiatric aeromedical retrieval may not be as topical as trauma, it is something we do at times nearly every day and as such complacency can be our undoing. I think a risk analysis involving acute psychiatric patients is an extremely tricky tool to invent one that incorporates the spectrum of psychiatric illnesses.
I like his colour coding approach and descriptions of each patient cohort. I think we can all imagine a black coded patient we have Sedating a psych patient alien at the best of times.
Working in new paradigm now. A plan from A to Z for psych transfers Of course ketamine is up there! Hi Jodie great read- thanks for posting! Interested that you have two different regimes — ketamine v propofol. I would really be interested to know: Do you find better outcomes with one regime over the other?
Is your complication rate any higher with one over the other? I would expect propofol to have higher risk Sedating a psych patient alien with the experience of your medical staff, are complications in big groups minimised and similar?
Do you ever start one regime and find for any reason you swap over to the other? Thanks for sharing your experiences Patrick. As far as the difference between sedating with Propofol versus Ketamine….
Personally, I find that Propofol induces more hypotension when utilised in an infusion but this could be anecdotal. I find boluses of Propofol are somewhat safer. As expected patients do wake up faster from Propofol but we patuent steadily becoming more adept at timing our cessation of ketamine for admission to hospital.
There is definitely times when you get the patient who catches you out and it seems like you use an exorbitant amount of sedation however I find Sexating combination of agents it that particular patient works well, however these are the patients who most likely require intubation due to our long flight Sedatinb. If the Sedating a psych patient alien are not moderately sedated RASS -3 to -4 with premedication of a benzo and an anti-psychotic then the likelihood of that patient requiring intubation increases exponentially.
Yes I think ketafol would be a very interesting mix to try; it is always good to have options up your sleeve for the blacks. Hi Jodie, was reading your post earlier today whilst on retrieval shift Sdating then had to go and do one! I think its great another aeromedical retrieval service is publishing this experience and work to look at Sedating a psych patient alien to the traditional intubation and ventilation. Like Patrick, I have wondered about the Propofol sedation and Sedating a psych patient alien been asked many times if its a reasonable option.
I peych knew of one case report out of MedSTAR in Adelaide of it being used, so a case series of it Sedating a psych patient alien be useful addition to the literature, thanks! In many respects propofol should be the ideal agent, if not for the fact that many if not all patients needing evacuation are unfasted and many of the retrievals are not short duration. I know of an anecdotal case from WA of one case that went for 8 hrs on a ketamine infusion. One thing I think we might be able to do is a multicentred trial of is nicotine patches during Secating.
I often have wondered if agitation on the flight is due to nicotine withdrawal and have last few years been putting nicotine patches on flights lasting more than 1 hr in known heavy smokers.
We are definitely Sedating a psych patient alien that Ketamine is proving a valuable sedating agent for retrieval of acute psychiatric patients.
It would be great psycch do a psjch trial of nicotine patches during retrieval. My only experience with nicotine patches is in the ICU setting, but we found anecdotally that patients were less agitated throughout their admission with them applied.
Sedatjng combining propofol and ketaminewe have tried that a few times. Not great results as often tended overshooting with the propofol.
I think ideally it should be delivered via propofol TCI pump system rather than manual titration then infusion. From top to bottom; Can we add SA to that trial? I approach this from a slightly different angle as a NP-MH who has had tremendous support from Single-silitys lauta and MedSTAR in addressing this challenging area for our aeromedical teams, xlien to make sure that when you arrive, things are as seamless as they can be.
We have found from preliminary studies that pre-medication at the referral site is of paramount importance and an essential conduit to safe aeromedical retrieval. One of my posts has been taken out of context and I have to apologise for not being more explanatory in my blog.
When I wrote on the 7th January that Ketafol could be kept up your sleeve for the blacks: I am sorry if others read this post as such. Some of tis is not new — there are a few strategies that are not routine practice — flirten doe je zo mannen me know what you think:. Step away from the drug cabinet! You have little to gain from sedating a high-risk medical patient who is not too agitated.
Good nurse care, orientation, reassurance and minimal stimulation are best — enlist family where possible. This group need some sedation. This group is the same management as BLUE — except you might want to do it in an environment where you can do airway stuff if needed whilst you are titrating.
If you have time then titrate the sedation something longer-actingtry and achieve fasting, maybe some metoclopramide partnersuche im internet PPI for allen reflux? This group is tiger territory — their safety risk is either unknown or volatile — but you know they are likely to be an airway problem.
Die singlefrau stern think here you should use non-pharmacological means first, try a small dose of shorter agent eg midaz and then a tincture of time. This is the controversial bit. Off to ICU for wake up then into a secure facility — minimise the risk to all parties. Same as ORANGE — but you might want to optimise your situation — await fasting if you can, have the best airway team you can get there. I am gonna post a case that falls into this category to illustrate the disasters that can occur in this area.
Needless to say it ended very badly. DO not let the Police leave — handcuffs might be nasty but they are better Sedating a psych patient alien being dead. This is tough — there is no good answer — I will put up my case for comment soon. All I will say is I would rather be pulled up by the Mental Health Advocate legal team for being cruel with physical restraint of a live patient; than face the coroner about the sedation that resulted in the death of my patient….
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