SPIT AT....AGAIN!

Specialties Emergency

Published

I am so tired of being spit on by patients! We all know the aggressive, out of control patients that spit. You're attempting four point restraints, they're growling snarling, someone holds their head so you won't get bit as 10 people try to restrain the maniac then comes the sound.....hawk! That I-am-collecting-a-large-loogey-in-the-back-of-my-throat-to-hit-you-in-the-face-with-sound. Anybody have a solution. Clearly regular masks don't work because they thrash around, get them dislodged, plus you risk being bitten while placing it. I was thinking bipap but it's pretty hard to get an order for bipap because someone is violent. Anyone come up with a solution for spitters? They're pretty hard to control. Our psych population has been unusually high lately for the summer and my fuse is wearing short.

Specializes in ER.

duck and cover. Do you have a mask on you? To avoid a big loogey in the eye or mouth.

Why not a mask on the patient, the kind that has loops over the ears? I have used those. Cops use those.

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Specializes in ED staff.

Being spit on on your clothing can be wiped off. If you can't get him/her to stop using legal avenues, protect yourself with the face shield. You can put on garb for isolation to protect your clothing too. We ALL feel your pain, unfortunately we don't have the power to make our patients behave the way we want them to. Who knows what's going on in their minds? They may be thinking they're being held captive, I've had patients screaming to the cops "Help I'm Being kidnapped!" Personally, I try to stay outta spit shot although being that I'm a nurse, I gotta touch them.

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Specializes in Trauma, Teaching.

Our EMS and police have spit bags. Totally worth it.

I've also seen them just grab the bottom of the guy's Tshirt and pull it up over the face.

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fortunately the last etoh cocaine abuse pt i saw had a trach.

he ended up on his icu room floor even while restrained x 3.

a doctor happened to be rounding and ordered him vented with diprovan

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Specializes in Emergency.

More so we protect ourselves by wearing masks and eye covers. Until we can get them calmed down(Chemically,Physically or if need be tubed)

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Specializes in LTC.

How often do you have time to get on full ppe when someone starts to become violent?

I like the shirt/gown/pillowcase/towel over the face until they are completely restrained.

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Specializes in GERIATRICS AND PRISON.

Well I say spit guard or what ever it is called by the civilian world. Yes I get a picture of what you are talking about. When they come my way with one of those on it will be a very bad night in my world.

We have a huge hood, four point restraint. Constant notes. and if I get lucky I can give them a shot or two.

If I think it will be bad I throw on the ppe equipment. when i retire I will write a book, the stories I could tell :smokin:

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Specializes in ER, NICU.

Yesterday, I broke the cardinal rule of nursing, I said a frequent flyers name. Sure enough a few hours later he comes rolling thru the door. When the doc denied him pain meds, went ballistic and spit on me. :eek:

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

This is why I never, EVER say names!! It never fails. So weird! Sorry that happened. :(

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Specializes in ER, IICU, PCU, PACU, EMS.
This is why I never, EVER say names!! It never fails. So weird! Sorry that happened. :(

It's like saying the "Q" word.....never fails!

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Specializes in ER, NICU.
It's like saying the "Q" word.....never fails!

Last time one of my illustrious co-workers uttered the "Q" word, she got pooped on (it looked like a porta potty got dumped on her), a cat fell through our ceiling tiles, and a hi-ball glass stuck in the rectum walked in thru triage.

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Specializes in ER.
I think many of you don't have a good mental image of the pt I am trying paint an image of. I am talking about young, healthy men. They're large and strong on any given day. Add ETOH and some cocaine, plus noncompliance with psych meds and add a heavy dose of ****** off. I am talking about a pt that can have 6 or so staff members, all men, including a cop laying on him and he can still throw people off. There is no putting a surgical mask on these people. Plus he is now biting and I don't want to put my little fingers that close to his mouth. It's almost impossible to hold the head still, but even if you can get the mask on, the pt will either literally eat it, or shake his head and move his mouth hard enough to dislodge the mask. Those things are a joke for most pts. I really did like the idea of the spit bag thing, but I don't think I'd be able to get our hospital to buy those for us. So the idea of the OB panties is awesome! We always have those handy and they'd be far easier to throw on someone who is uncooperative than trying to loop the elastic of a mask over the ears. We have had several pts wind up getting tazed in our ED but unfortunately sometimes these things are going down before our on duty cops shows up, or the cop on may not carry a tazer, etc. I may preemptively just put panties on everyone's head while putting on the restraints. Of course when I am no longer in spitting range, I'd take it off. Also, strangely we have had pt's who were this violent and aggressive but we were unable to give our usual B52's due to contrandications. One was straight out of surgery believe it or not. Also, even if I am giving IMs, I am still in spit range plus no medication is immediate acting unless given IV. The one pt I am referring to here actually had an IV that he ripped out with his mouth while in restraints. He then tried to eat the catheter and attatched tubing. Anyway, panties, great idea!

On a side note I don't see why you can't have someone restrained with bipap on. I have had unrestrained pts not remove the bipap while they actively vomited into the mask. Plus, if I did use it for a non respiratory purpose, couldn't I just turn down the rate and amt of forced air. I think ours have controls for all that. Just because it is on doesn't mean it's blowing. You could attatch O2 for blow by purposes, right?

um, I think "most" of us DO understand the image you're trying to paint, because we've been there. And by the way, I'm more than capable of handing an elbow to a neck or sitting on a patient far more effectively than "most men" that respond to these ED patients. What a comment. Shouldn't underestimate a fit and strong nurse. Most ER nurses are more than capable - it's gender stereotyping that irritates the crap outta me. If you are capable of effectively restraining a patient is the issue, not being male or female, so don't make it about that. If you're weak and have no business participating in restraining, then own it. If you're unable to for whatever reason, that's fine, but don't label that even "all guys" couldn't tame that beast. It's just laughable.

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