Most of us will have seen patients like this – agitated, aggressive and often with police or security pinning them down.
- High risk of Cardiovascular Collapse/Death – likely due to adrenaline surge, heat exhaustion and injury. It can happen very suddenly.
- Keep physical restraint to a minimum – Don’t allow patient to forced face down, it’s the most likely way of killing them.
- Tranquilisation vs Sedation – Obviously oral tranquillisation is our first step, however, this is not always practical and needs to have a senior review and dynamic risk assessment .
- Aggressive management of underlying issues – esp. hyperthermia and acidosis and look out for rhabdomyolysis and DIC
Refusing treatment = Mental Capacity Assessment [LINK]
The Trust Guide: Rapid Tranquilisation give a full in-depth guidance on tranquillisation and steps leading up to this. It also outlines altenitive oral and IM medications.
RCEM -abd Provides more in-depth guidance on those patients heading toward sedation
