Tag: capacity

Mental Capacity Act (2005)

Applies to all over 16’s

Principles

  1. Everyone is presumed to have capacity – until a lack of capacity has been established
  2. All practical efforts have been made to help patient make a decision
    • Explain decision and options as clearly and concisely as possible (be flexible)
    • Make every effort to help the person understand (language line, writing, etc.)
    • Are there others who might help them understand? (nursing, medical, family, freinds)
  3. People are free to make an unwise decision
  4. Anything done under the act MUST be in the patients best interest
  5. Carefully consider what is the least restrictive option

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Acute Behavioural Disturbance / Excited Delirium

Most of us will have seen patients like this – agitated, aggressive and often with police or security pinning them down.

  1. High risk of Cardiovascular Collapse/Death – likely due to adrenaline surge, heat exhaustion and injury. It can happen very suddenly.
  2. Keep physical restraint to a minimum – Don’t allow patient to forced face down, it’s the most likely way of killing them.
  3. Sedation – if you’re restraining you will almost certainly need to sedate. IV is best but if access is too risky IM will have to do.
  4. Aggressive management of underlying issues – esp. hyperthermia and acidosis and look out for rhabdomyolysis and DIC

Refusing treatment = Mental Capacity Assessment [LINK]


DrugRouteTypical Dose (mg)Onset (min)Duration (min)Warning
MidazolamIV2-51-530-60Respiratory depression, IM unpredictable onset
IM510-15120-360
LorazepamIV2-42-560-120
IM415-3060-120
HaloperidolIV5-1010180-360Arrhythmia Risk: Only if previously used OR ECG
IM10-2015-30180-360
KetamineIV1-2mg/kg120-30Theoretical risk of worsening cardiovascular instability
IM2-4mg/kg3-560-90

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