Airway: intact - patient is screaming at you
Breathing: intact, patient tachypneic, lungs CTAB
Circulation: intact, WWP
VS: AF BP 140/90, P 120, RR 22, O2 sat 94%
FS glucose 126
Verbal de-escalation techniques can be remembered with the SAVE mnemonic:
Support: "Let's make you feel better"
Acknowledge: "I see you're very uncomfortable"
Validate: "It's reasonable for you to be upset
Emotion naming: "You seem angry"
Despite your best efforts, the patient becomes threatening and tries to bite a nurse. Security guards intervene and pin him to the bed.
You consider your other options.
The patient should be kept in supine position with the head at 30°, one arm above his head, one arm by his waist. The restraints should be removed as soon as safely possible.
*All patients who are physically restrained must also be chemically restrained!
Commonly used medications:
Benzos - lorazepam 1-2mg SL, midazolam 5mg IM
Antipsychotics: haloperidol 5-10mg IM
Ketamine 4-5mg/kg IM
*Monitor patients for respiratory depression, excessive sedation, NMS (haloperidol), laryngospasm (ketamine).