Quote from nurseT
Hi all, I work in a max county jail. We seem to get all the mental patients who have been off their meds for who knows how long. If the inmate gets out of control and has to be placed in the restraint chair, our Dr. has me use a coctail of sorts: Hadol 5mg and Benedryl 50mg IM. This Tx is reserved for the really nutty ones. I mean, when there's no time to get out your little alcohol wipe and there's six officers holding this pt down, so you do an intradenim, if you know what I mean. I have found that this little coctail doesn't do anything for the real nuts. They will still be up thinking they're spiderman. What do you use for these circumstances. I would really like to deal with this in a more dignified manor with a coctail that actually works. I don't want to knock the pt out but would like to see them get some immediate relief from the psychosis. any suggestions would be great, esp. if it's something with good clinical results that I can present to the Dr. Our mental health provider is noooo.. help. Thanks, T
I work in Mental Health in Queensland, Australia. We have a Medium Secure Unit which holds mainly Forensics patients and Psychiatric Intensive Care Unit within each acute inpatient units. We use Acuphase, Olanzapine and Midazolam as these are quick acting IMI.
I also work in the Community and we administer Haldol and Risperdal Consta, Zuclopenthixol, Flupenthixol and minimal Modecate as these are long acting IMI depots.
We hardly do 'intradenim' due to infection control. We rely on really good techniques of take-down and also numbers of persons. So, have nurses ready to administer fast acting IMI and they are usually not involved in the take-down. We do not have restraints such as the 'chair', it's against the law. But patients who have been given fast acting IMI and have been violent and aggressive are usually placed in seclusion under some kind of observation, even if they are a Forensic patient.
I have not heard of Haldol IMI being used in the circumstances you mention for a very, very long time. And yes, how old are your psychiatrists? There have been a lot of research and evidence based practise policies about management of violent, aggressive and basically really unwell patients. And I mean there are lots of research on it. I can recall nurses going to the Union because their doctors would not budge from their usual practise.
I hope my input has helped.