2. What’s that?
What it is not
• Takeover by a « guru »
• Unwanted acts
It is
• Physiological state
• Natural
• Subconscious protection
Dr Arnaud Depil Duval - Urgences Evreux Vernon
3. Hypnosis?
• Only hypno-analgésia
• Not a complet hypnosis therapy
• Hypnose adaptée à la mission des urgences
Dr Arnaud Depil Duval - Urgences Evreux Vernon
4. Hypnosis in emergency department, a reality?
• Noisy Atmosphere
• Major stress
• A patient who suffers
• But if it made it easier?...
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Man with acute coronary syndrome in firefighters van.
Pain evoluate from 8/10 to 2/10
5. When use hypno-analgesia
in emergency department?
• Arterial puncture
• Lumbar puncture
• Thoracic drainage
• Dislocation
• Fracture
• Suture (face+++)
• Prepare sedation for invasive
acts
• Acute Coronary Syndrome
• Non invasive ventilation…
Dr Arnaud Depil Duval - Urgences Evreux Vernon
6. From positive communication to hypnosis
• Base of hypnosis
• Always use positive terms
• Avoid negative terms :
• Don’t panic
• No stress
• Be careful, i will going to sting
Dr Arnaud Depil Duval - Urgences Evreux Vernon
7. Speaking about hypnosis
• Rule n°1 : It is forbidden to say “hypnosis”
• Rule n°2 : It is forbidden to say “hypnosis”
• Rule n°3 : Get patient acceptation
• Rule n°4 : If opposition, stop hypnosis
• Rule n°5 : Use transitions sentences and adapted attitudes
Dr Arnaud Depil Duval - Urgences Evreux Vernon
9. 3 « Yes »
• Get acceptance from patient
• Knock down oppositions
• Obvious questions :
• Could you look a point on the wall?
• Do you hear sounds around you?
• Could you feel the stretcher?
Dr Arnaud Depil Duval - Urgences Evreux Vernon
10. Positive communication
• Expliquer le geste avant
• Et ne plus en reparler
• Choisir ensuite des formules adaptées et positives :
• L’infirmier va faire ce qu’il a à faire
• L’infirmière va faire le soin
• Je vais faire le geste
Dr Arnaud Depil Duval - Urgences Evreux Vernon
11. Analgesic ou co-
analgesic?
• Tell patient :
• “We prepare a treatment to ease
you”
• “During this step, we can try
something else to help you…”
• Limit anxiety
• Multi-modal analgesia
Dr Arnaud Depil Duval - Urgences Evreux Vernon
15. Imagination
The more you
are in this
place and the
stronger the
protection is
Think of a
place you like
or an activity
you like
Dr Arnaud Depil Duval - Urgences Evreux Vernon
16. Pediatric version
• More directive
• Think of something you like to do
• The more you are in this place and the flabbyer
your arm ...
• Use respiration to escort activity
Dr Arnaud Depil Duval - Urgences Evreux Vernon
17. Be careful
• Avoid asking for the
description
• it can be
embarrassing…
• Depend of the
referencial of
patient
Dr Arnaud Depil Duval - Urgences Evreux Vernon
19. Controlled respiration
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Feel the air enter your right
nostril
Then in the left
Feel the air fill your lungs
And your diaphragm will go
down and up
The more you feel your
diaphragm lower and rise and
the stronger the protection
21. Catalepsy of the eyelids
Close your
eyes
You will
pretend
that the
eyelids are
glued to
each other
with glue
You will
pretend to
test their
closure as
if your
eyelids
were stuck
to each
other
Your eyelids
are glued to
each other
The more your
eyelids are glued
to each other
More
protection
is strong
Dr Arnaud Depil Duval - Urgences Evreux Vernon
23. Multiply the techniques
• Use many techniques if needed
• Abandon one technique for the
benefit of another
Controlled respiration
Catalepsy of the eyelids
Imagination
Dr Arnaud Depil Duval - Urgences Evreux Vernon
24. Multiply the
techniques
You can keep your eyes
open but it's more
comfortable if you close
them
Breathe through the
nose, feel the air enter
your nostrils; the right
then the left
You will pretend that
your eyelids are glued
to each other
You're going to pretend
to test their closure,
you'll pretend nothing
could take them off
The more they are glue
and the stronger the
analgesia
And at the same time,
you're going to think of
a place you like or
something you like to
do
And the more you are in
this place, the stronger
the analgesia
26. Exit
• Soft
• Don’t say “It’s almost done”
• Escort the “surfacing”
• Respect the rhythm of the patient
• Eventually incite "Now you can heal your
eyes“
• Always finish with positive note
27. If it doesn’t work?
Dr Arnaud Depil Duval - Urgences Evreux Vernon
28. Failure
• Useless to insist
• Do not make the patient feel
guilty
• But possibly use another
technique ; starting with the
distraction
Dr Arnaud Depil Duval - Urgences Evreux Vernon
30. Self-hypnosis
• Promotes power nap (micro nap)
• Potential optimization technique
• Partnership with the Sports
• French Air Force and IRBA
• Stress and fatigue management
Optimization of tasks
32. Trainning
Few hypnosis
Few trained staff
Long training
Complete All technics Long Expensive
« Everyday » hypnosis
Mass trainning
Short trainning
Only analgesia Fast Cheap
Dr Arnaud Depil Duval - Urgences Evreux Vernon
37. Supplied by the
patient ...
• Do not store smartphones
• Use them!
• "The more you are with your Facebook and
the stronger the protection is"
Dr Arnaud Depil Duval - Urgences Evreux Vernon