Stop laughing, you’ve probably heard someone suggest that this might be a good way to administer sedation to acutely agitated patients.
I think once you’ve had to do this more than a few times, you realise that the ongoing management doesn’t stop when the patient settles – they’re now relying on us to ensure their safety, which can feel somewhat paradoxical given that (at some level) we were probably feeling uneasy only moments earlier.
This post from Tim Leeuwenburg discusses some lessons learnt from when things go wrong and introduces some valuable points to consider;
The take-away here is that we should be thinking about managing acute agitation as a procedure that is a continuum of our care, not an end-point in our management.
If this is starting to make sense, you might be interested to know that ALiEM have an entire self-paced learning module in their ALiEMU which steps you through Procedural Sedation and Analgesia in the ED;
Some time ago, I got at least $1,000 of free advice from an outstanding pre-hospital practitioner – to paraphrase – if you can anticipate what happens next, you won’t get an unwelcome surprise !
On more than one occasion I’ve been heard to say “just because you can, doesn’t mean you should” – consider the scenario of an unconscious (and anonymous) patient who has a mobile phone that you could unlock with a press of their thumbprint.
Here’s a noteworthy post from St. Emlyn’s blog by Simon Carley that discusses the legalities of doing so (with a UK slant);
I think the law of necessity would probably be the relevant principle to rely on in Australia –
perhaps Michael Eburn from the Australian Emergency Law blog would provide some commentary ? provides his view in the comments section below.
(and please encourage your patients to use the ‘Emergency ID’ feature of most modern mobile phones)
TLDR; Every situation is different – consider your patient’s expectation of confidentiality and the need to access this information pre-hospital if you’re going to do it.
I’m working on an event car tonight (yes, I know) and it occurred to me that there are likely a number of people presenting at hospital over the next 24 hours that might not really need to be there.
Here’s a great (albeit older) article from the folk at Guy’s & St Thomas’ via PubMed that discusses their revised recommendations for revellers who appear to be unwell, but in context, might not need to present at the local emergency department.
Something to think about.
My best wishes for your year ahead.
As you may have noticed, I’m a huge fan of the work of the Academic Life in Emergency Medicine (ALiEM) team.
They’ve had the foresight to put together an app for the two most popular flavours of handheld devices to access their library of Pacius Verbis (PV) cards which are short, right-to-the-point references for 146 topics (at last count) that you are likely to be interested in;
You’ll also see that you can purchase some paid content through the various app stores, but take some time to browse through the free stuff first..
Cool effectively, cool aggressively.. I’m seeing more literature about cold water immersion in the ED providing hyperthermic patients with better outcomes;
And don’t forget the part that benzodiazepines play in settling the hot, agitated patient.
Where I work, summer is just about upon us – here’s a reminder of some important points from the gang at EMDocs;
It’s an important law – this short post nails the point – the awake and alert patient can fake us out;