Chemical Restraint Usage In Emergency Medical Care

The patient is a 72-year-old female who arrived to the emergency department in cardiac arrest. Emergency medical services reports the patient was last seen eating breakfast at her nursing home and was found an hour later face down and unresponsive. After it was determined the patient was in asystole, an intravenous catheter was started and two rounds of Epinephrine was administered. Upon arrival to the emergency department the patient had pulseless electrical activity with sinus tachycardia on the monitor. Airway management was in process with a bag valve mask on 100% oxygen and chest compressions in progress. After intubation and stabilization the

Lack of enough trained staff in conscious sedation available at the time of the procedure

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

In 1985 the U.S. Supreme Court ruling in Tennessee v. Garner severely restricted the circumstances under which law enforcement officers may use deadly force to arrest a suspect. In assessing the reasonableness of a deadly force seizure per the fourth amendment, the Court ruled that the need for a police intrusion had to be weighed against its risks, and determined that common law any-fleeing-felon statutes were unconstitutional. In a narrative give the facts, issues, and court holdings.

On arrival to UKMC the patient received a Glasgow Coma Score of 3, which is an indication that intubation is needed. Bipap therapy was attempted but failed, due to respiratory failure. This was confirmed by arterial blood gases. After being assessed by the team at UKMC, the patient was intubated for respiratory failure, as well as shock of an unclear etiology. Rapid sequence intubation drugs, Etomidate and Succinylcholine where administered prior to intubation. A 7.5 endotracheal tube was used

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

Multiple studies demonstrate a relationship between lower patient-to-nurse ratios and improved patient outcomes (Garrett, 2008; Penoyer, 2010; Unruh, 2008). Patient outcomes addressed in the various studies included falls, infections, length of stay, mortality, patient safety, patient satisfaction, postoperative complications, pressure ulcers, quality of care and unplanned extubation with reintubation. A 2004 report from the Agency for Healthcare Research and Quality (AHRQ) stated that adverse events can increase the cost of a total treatment by 84%, length of stay by 5.1 to 5.4 days and probability of death by 4.67% to 5.5% (Garrett, 2008).

Description: Ketamine is a nonbarbiturate, sedative hypnotic used parenterally to provide anesthesia for short diagnostic and surgical procedures. It is also used as an inducing agent, as an adjunct to supplement low-potency anesthetics such as nitrous oxide, and as a supplement to local and regional anesthesia. Ketamine can be used concomitantly with muscle relaxants without complication because it does not provide muscle relaxation of its own. It is a fairly short-acting agent that provides a profound, rapid, dissociative state and a short recovery time.

It is appreciated that the given case study contains other factors such as psychological trauma and the impact of blood loss. However this essay is going to explore the efficacy of pre hospital immobilisation utilising cervical collars and extrication/ orthopaedic stretchers, reflecting on an account from the paramedic’s practice. A modified framework of Gibbs Reflective cycle (1988) will be used. Including Description, Feelings, Evaluation, Conclusion and Action Plan. This essay is supported throughout using relevant evidence and seminal work.

Exclusion criteria included patients with BMI less than 30kg/m2 , younger than 18 year, hade ASA physical status IV or V, required a nasal intubation, , or were at risk of regurgitation and aspiration (hiatus hernia, not fasted, or esophageal reflux). Also, patients with anticipated impossible intubation will be excluded [as patients with a history of impossible intubation, mouth opening (interincisor distance) less than 20 mm, or cervical spine fixed in flexionwere excluded due to susceptibility of impossible intubation.

There have been several studies attempting to clearly identify the risk factors for the extubational difficulty. First of all, Demling et al. prospectively investigated the use of standard criteria for extubation in 700 patients in ICU, but could not find any good predictors for extubation failure (Demling et al., 1988). Leak test is still the controversial routine choice of many practitioners used to predict the potential occurrence for airway edema evaluating whether the airway caliber is sufficient for ventilation (Chung et al., 2006; Ding et al., 2006; Kriner, Shafazand & Colice, 2005). In one study, the evaluation of the leak test in 72 spontaneously breathing ICU patients indicated that the presence of a cuff leak may associated with

Objectives: The primary purpose of this study was to determine the level of agitation that psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was to determine whether the level of agitation changed over time depending upon whether the patient was restrained or unrestrained.

The patients were assessed in the Pre –anaesthetic clinic. Data collected was entered in a pre-structured questionnaire.