Acute behavioral disturbances (ADD DRUGS) Flashcards
what is the preferred sedation for a patient who has not responded or n/a droperidol, if under the influence of meth
midazolam over ketamine
What is the age limit for patients to be considered under this guideline for acute behavioural disturbance?
Patients aged greater than or equal to 12 years
Seek clinical advice if the patient is aged less than 12 years.
What should be determined regarding the patient exhibiting acute behavioural disturbance?
The level of risk to safety of the patient, personnel and bystanders.
List some underlying clinical conditions that may cause acute behavioural disturbance.
- Acute alcohol and drug intoxication
- Drug or alcohol withdrawal
- Acute psychosis
- Dementia
- Traumatic brain injury
- Hypoglycaemia or hyperglycaemia
- Sepsis or another generalised inflammatory process
- Epilepsy
- Neurodevelopmental disorders
What is the recommended approach for treating a patient with acute behavioural disturbance?
Use the minimum amount of sedation and restraint to achieve psychomotor control and minimise the risk of harm.
What action should be taken if a patient poses a mild to moderate risk to safety?
Attempt verbal de-escalation and move sequentially through specific steps.
What medication can be administered if the patient will take oral medicine?
Olanzapine: 10 mg PO, may reduce to 5 mg if caution is present.
What should be done if olanzapine is ineffective?
Administer droperidol: 10 mg IM/IV, may reduce to 5 mg if caution is present.
Fill in the blank: If droperidol is ineffective, administer _______.
midazolam
What is the IV dosage for midazolam if required?
2-3 mg every five minutes as required, may reduce to 1-2 mg if caution is present.
What is the maximum dose of ketamine that can be administered IV?
1 mg/kg (up to a maximum of 100 mg) every five minutes as required.
What should be done if the patient has an altered level of consciousness?
- Position the patient on their side
- Provide safe restraint
- Administer oxygen
- Continually monitor the patient’s airway, breathing and vital signs
- Gain IV access if not already achieved
What backup must be requested for severe to immediately life-threatening risk to safety?
Backup from an ICP/CCP.
When must a patient be transported to an ED by ambulance?
If droperidol, midazolam, or ketamine has been administered.
What is considered a key aspect of successful verbal de-escalation?
Allow sufficient time, maintain a safe distance, and use a calm voice.
What are examples of mild to moderate risk to safety?
- Verbally aggressive
- Actions not involving immediate risk of serious harm
- Pulling at equipment
- Trying to climb off the stretcher
- Agitation preventing control of moderate external bleeding
What are examples of severe to immediately life-threatening risk to safety?
- Dangerous physical aggression
- Wielding a weapon
- Actions involving immediate risk of serious harm
- Destruction of physical surroundings
- Trying to get out of a moving ambulance
What is the recommended approach for providing sedation?
Use the minimum amount of sedation required, matching the choice and dose to the level of risk.
When administering droperidol, which route is as effective?
The IM route.
What should be done if IV access cannot be obtained?
Administer IM midazolam or droperidol.
