Sedating a combative patients
However, recent studies suggest that routine use of adjunctive midazolam with ketamine does not effectively reduce the incidence of these emergence phenomena. If not countered by indirect effects e.
Such protocols should be regularly updated. This does not hurt you or them - it hurts the patient. Hypoactive delirium, although not often recognized, has a worse prognosis and is characterized by psychomotor retardation manifested by a calm appearance, inattention, and decreased mobility.
Chloral hydrate has no analgesic properties and should be combined with an analgesic agent such as an opioid if analgesia is required. But as I said, sometimes a conservative approach is better than a overzealous approach when experience and skill is in question. In some instances, reversal of opioids with naloxone or benzodiazepines with flumazenil may be indicated.
Ideally, this should be performed on a daily basis. When feasible, this person should have an unobstructed view of the patient's face, mouth, and chest wall throughout the procedure.
The hyperactive form presents with agitation, combative behaviour, and progressive confusion, often despite sedative therapy. Pulse oximetry remains the most widely used monitor during procedural sedation.
The Violent and Agitated Patient
Ketamine-induced hypertension and tachycardia can be decreased by the administration of ketamine with a benzodiazapine, a barbiturate, propofol, or a synthetic opioid. These cardiovascular effects are especially pronounced following bolus administration. If that would have meant that a couple extra minutes would have been spent on the scene to start the process, it would have been appropriate. Ketamine Ketamine is the only dissociative anesthetic agent currently in clinical use.
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