Positional/Restraint asphyxia and Acute Behavioral Disturbance Flashcards
Positional/Restraint Asphyxia - definition
Occurs when the position of the body interferes with respiration, resulting in asphyxia.
Patient not able to alter their position due to restraint.
Positional/Restraint Asphyxia - Risk factors include
Patients position resulting in partial or complete airway obstruction.
Patient left face down/prone.
Pressure applied restricting the shoulder girdle or accessory muscles whilst laid down.
Positional/Restraint Asphyxia - Factors increasing risk
Drug/alcohol intoxication.
Physical exhaustion
Mental illness
Obesity
Acute Behavioural Disturbance - information
A syndrome in which the patient exhibits bizarre and manic behaviour. Can prove rapidly fatal. Linked to positional asphyxia Often referred to as excited delirium Considered a medical emergency
Acute Behavioural Disturbance - definition
A rare form of severe mania, sometimes considered part of the spectrum of manic depressive psychosis and chronic schizophrenia.
Acute Behavioural Disturbance - Causes
Psychiatric illness
Drugs (particularly cocaine)
Alcohol
Combination of these
Acute Behavioural Disturbance - Risks
Rapid deterioration and death due to cardiac arrest from drug-induced arrhythmias.
Greater risk of positional asphyxia, especially in obese patients.
May be exacerbated by exhaustion e.g. following struggle.
Acute Behavioural Disturbance - has been linked to
Head injury Brain Tumours Delirium/high temperature Heat exhaustion endocrine (hormone secretion system) disorders Hypo/Hyperglycaemia Thyroid disease Drugs; anti-psychotic/cocaine.
Acute Behavioural Disturbance - signs and symptoms
Bizarre and/or aggressive behaviour Impaired thinking Disorientation Hallucinations Onset of paranoia
Acute Behavioural Disturbance - presenting features (things to look for)
Agitation Excitability Paranoia Aggression Non pain-compliant Great strength Sudden collapse May ultimately result in death!
Acute Behavioural Disturbance - features
High level of physical strength
Sweating, fever, heat intolerance, hot to touch
Removal of clothing
Decreased/absent response to pain
Sudden tranquillity after frenzied activity which may mask level of consciousness
Acute Behavioural Disturbance - management stage 1
If police on scene, should already be trained in safe management.
Summon police assistance if not present.
Do not place self at risk.
Monitor patient for deterioration.
Consider position of patient when restrained - sitting or kneeling, lying on side. NOT FACE DOWN!
Acute Behavioural Disturbance - management stage 2
Personal safety is paramount. Ideally the patient should be contained rather then restrained. When safe, conduct primary survey. Treat as required. Document observations. Secondary survey if possible/required. Ideally transport in ambulance. Transport to A&E.
