disturbed patient retrievals' by minh le cong (feb 2012)
DESCRIPTION
Minh Le Cong's presentation (recorded in an aircraft hangar in Northern Queensland) on the aeromedical retrieval of the disturbed, agitated or violent patient.TRANSCRIPT
Disturbed patient retrievals
By Dr Minh Le Cong
RFDS Cairns, February 2012
•WHAT WE ARE GOING TO TALK ABOUT
TODAY
•Legalities
•Risk assessment
•Restraint
•Sedation
•Emergencies
Online survey of Australian retrieval doctors’ opinion of disturbed
patient management
•Emailed survey invitation to
32 retrieval doctors,
December 2011
•3 question anonymous
survey
•17 respondents
•Open comments from respondents
were...
Legalities of aeromedicine
•Mental Health Act
•Guardianship Act
•Civil Aviation Act
Risk Assessment
RFDS QLD Revised Risk Assessment tool ,2010
What is the risk here?
• 40 yo man with chronic back pain in rural
hospital
• Referred for investigation ? Disc
prolapse..can’t sit due to pain
• Agitated and demanding analgesia and wish
to smoke frequently
Why don’t we use this?
Physical restraints in aeromedical
setting • RFDS QLD protocol
• Restraints – quick release, velcro fasteners, 4 points
• RFDS SA – body net
• Patient explanation if possible prior to use
• Police restraints
• Careful medical monitoring during use
• Avoid prone position
• Avoid patient struggling against restraints (SEDATE!!)
RFDS Central section restraint
Check out www.emcrit.org
Sedation
Sedation trivia questions • What was the DORM study?
• What are the recommended acute
sedatives in Queensland mental health
units?
• What is the safest route of sedation : oral,
intranasal, intramuscular , intraosseous or
intravenous??
Air Med J, 31:1, 2012
What would you prepare and how would you give it?
DOES FASTING MATTER AND DRUG CHOICE??
Let’s try an example
•37yo woman with acute
suicidal ideation, refusing
admission
•PMH – antisocial personality
disorder, past conviction for
stabbing police officer
•PMH : sleep apnoea, obesity
•OE: BMI 40, BP 120/60,
SaO2 99% on air
•Handover : cooperative
with IV access, demanding
cigarette
My approach
Run it like procedural sedation
•Set up for RSI..you may
need it
•Ketamine infusion
(adjunctive midazolam prn)
•Non invasive capnography
ON ketamine 80mg/hr
Restraints on, infusion running, more sedation ready
Use a sedation score
Inflight emergencies
“No one f#$@s with a 100 of sux”
•Yes or no?
•Is ketamine IMI as good?
•Is midazolam IMI as good?
DO YOU HAVE TO INTUBATE ALL HIGHLY
COMBATIVE PATIENTS FOR FLIGHT?
Check out the following presentation
•http://www.isas.org.au/img.
ashx?f=f&p=christchurch_2
010%2fExtreme+Psychiatric
+Patient+-
+David+Bowie.pdf
•WHAT WE TALKED ABOUT TODAY
•Legalities
•Risk assessment
•Restraint
•Sedation
•Emergencies
Thankyou!