'Disturbed Patient Retrievals' by Minh Le Cong (Feb 2012)

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Minh Le Cong's presentation (recorded in an aircraft hangar in Northern Queensland) on the aeromedical retrieval of the disturbed, agitated or violent patient.

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'Disturbed Patient Retrievals' by Minh Le Cong (Feb 2012)

  1. 1. Disturbed patient retrievals By Dr Minh Le CongRFDS Cairns, February 2012
  2. 2. •WHAT WE ARE GOING TO TALK ABOUT TODAY•Legalities•Risk assessment•Restraint•Sedation•Emergencies
  3. 3. 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
  4. 4. •Open comments from respondents were...
  5. 5. Legalities of aeromedicine•Mental Health Act•Guardianship Act•Civil Aviation Act
  6. 6. Risk Assessment
  7. 7. RFDS QLD Revised RiskAssessment tool ,2010
  8. 8. 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
  9. 9. Why don’t we use this?
  10. 10. Physical restraints in aeromedicalsetting • 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!!)
  11. 11. RFDS Central sectionrestraint
  12. 12. Check out www.emcrit.org
  13. 13. Sedation
  14. 14. 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??
  15. 15. Air Med J, 31:1, 2012
  16. 16. What would you prepare and how would you give it?
  17. 17. DOES FASTING MATTER AND DRUG CHOICE??
  18. 18. Let’s try an example•37yo woman with acute suicidal ideation, refusing admission•PMH – antisocial personality disorder, past conviction for stabbing police officer
  19. 19. •PMH : sleep apnoea, obesity•OE: BMI 40, BP 120/60, SaO2 99% on air•Handover : cooperative with IV access, demanding cigarette
  20. 20. My approach
  21. 21. Run it like procedural sedation•Set up for RSI..you may need it•Ketamine infusion (adjunctive midazolam prn)•Non invasive capnography
  22. 22. ON ketamine 80mg/hr
  23. 23. Restraints on, infusion running, more sedation ready
  24. 24. Use a sedation score
  25. 25. Inflight emergencies
  26. 26. “No one f#$@s with a 100 of sux” •Yes or no? •Is ketamine IMI as good? •Is midazolam IMI as good?
  27. 27. DO YOU HAVE TO INTUBATE ALL HIGHLY COMBATIVE PATIENTS FOR FLIGHT?
  28. 28. Check out the following presentation•http://www.isas.org.au/img. ashx?f=f&p=christchurch_2 010%2fExtreme+Psychiatric +Patient+- +David+Bowie.pdf
  29. 29. •WHAT WE TALKED ABOUT TODAY•Legalities•Risk assessment•Restraint•Sedation•Emergencies
  30. 30. Thankyou!

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