ABD Flashcards
ABD signs
Agitation
Constant physical activity
Bizzarre behaviour inc paranoia, hypervigilance
Fear, panic
Unusual or unexpected strength
Sustained non compliance w police/ ambulance
Pain tolerance
Hot to touch
Sweating
Tachycardia
Tachypnoea
Indications for transfer to ED on suspicion of ABD
Tactile hyperthermia
Near constant physical activity
Extreme agitation or aggression
‘ Treat the triad’ in ABD
Agitation and exertion
Acidosis and Rhabdomyolysis
Hyperthermia
Causes of ABD
Adrenaline
Stimulant drugs
Mental health
Medical conditions
How does ABD cause acidosis
Incr sustained activity -> incr CO2 -> acidosis
Legislation describing criminal and civil use of force
Criminal
- common law
- Section 3 criminal law act
- Section 117 of police and criminal evidence act
Civil
- mental health act
- mental capacity act
De escalation techniques
Change environment
Refreshments
Cigarettes
Communication
ABD tx
Early recognition
Sedate early
ICU/anaesthetics involvement
High flow O2
Aggressive IV fluids
Active cooling
Drugs for procedural sedation
IV/IM ketamine (1st line)
- IV 1mg/kg, IM 4-5mg/kg
IM Droperidol - 5-10mg
IV/IM Midazolam
Considerations in ABD mx
Safety officer
Cannulation plan
Monitoring
Contingency planning
How many people are ideally needed to physically restrain a person
5
Safety officer
Clear team leader who does not engage in restraint
Able to protect and support head and neck if needed, check airway and breathing not compromised, monitor obs
Which position is best in physical restraint
Avoid taking to floor if possible
Supine better
Avoid Prone , use for shortest time possible
Danger zones in physical restraint
Rib cage
Neck
Abdomen
Obstructing mouth and nose
Avoid eyes and ears
5 person technique for restraint
Safety officer - head
1 on ACh arm - hold shoulder and forearm, internally rotated, hold arm to floor/bed
1 on thighs
1 on lower legs - cross over legs
