1. is the dorsogluteal site used in emergency med administration? if the person is in restraints, which site is preferred? or is this an institutional policy thing?
i use whatever muscle i can get to. i personally prefer the vastus lateralis. sometimes a patient is more cooperative if they can get the medication in the deltoid...and depending on the medication, i may give it there. if i can't give it in the deltoid (for example, phenergan), i'll explain why.
3. do you aspirate for blood return when you're giving an im med to a combative patient?
always. it just takes a second.
4. the facility i was in before gave some injections in the deltoid -- mostly just 0.5cc ativan, etc. are there certain meds you wouldn't give in this spot, even if it were a small amount?
phenergan (promethazine) because it burns like hell and really needs to go into a deep muscle. most patients who insist on phenergan in the deltoid regret it.
5. say a patient is being actively combative, violent, etc. and has to be put in restraints or held to keep others safe. at what point do you offer a prn med? before they are restrained? after they are restrained? i've seen this all move very fast, and i know i'll be responsible for documenting it -- say the patient has already "crossed the line" of safety, verbal deescalation isn't so much an option, and has to be restrained, do you then give them the option of taking a po prn, or is it acceptable to "force" medicate them with rationale that they are/have been a danger to others unmedicated?
the goal is to not have the patient end up in restraints, so offering prn meds should be one of your first interventions. as soon as you see them escalating, step in and offer it. if they're agitated but not yet out of control, i'll offer the choice between po and im...and to be honest, it's usually a 50-50 split between the routes. i believe giving them the choice of route helps because it gives them a sense of control, at least about one thing. sometimes a feeling that they have a little control in the situation is all they want.
if they are so far out of control that they are an immediate danger, then all bets are off--patient safety is first and foremost. if they're in restraints the route is often im (i've seen too many things spit back at staff) but occasionally we will offer it po.