My CoWorkers Were Brilliant During A Code Last Night!

[Meerkat]

I had to call a code on an adolescent patient last night because she took the buckle off her shoe and put it in her mouth, threatening to swallow it. (this was the second code on her in an hour's time. she already got an emergency treatment of 5mg haldol with 2mg ativan and it didn't touch her)...So We had big men come down to the code because she is a big girl...a few were holding her down, and I thought, how on earth are we going to get that buckle out of her mouth? After a few minutes of cojoleing and trying to force her mouth open...someone did something that made her voluntarily open her mouth...and out came the buckle. Can you guess what it was?

They tickled her feet!

This is in contrast to an incident earlier this year, which I question and would like your opinions on please. Another pt held something in her mouth, and in order to have her open it, they held her nose. She did open her mouth for air, but isn't this very dangerous, if not illegal? I mean cutting off comeone's air while they are being physically held down...

[JeanettePNP, MSN, RN, NP]

How big was the buckle?

[Meerkat]

How big was the buckle?

About three quarters of an inch by three quarters of an inch.

[jnette, ASN, EMT-I]

hmmmmmmmmm............. sounds like a pretty good idea, but could also have backfired if the girl had started laughing/gasping and had accidently aspirated the buckle.

I'd have made sure she was lying on her stomach or at least on her side before tickling those feet.

I wonder if standing behind her and doing a Heimlich maneuver would have worked. I know she wasn't choking, but perhaps just the thrust of the abdominal PUSH would have forced her to open her mouth, anyway.

Good topic. :)

[Meerkat]

How do you guys get patients to give up something in their mouth?

[TxPsychNx]

I think the foot tickling was sheer brilliance. Yes, she could have aspirated-but she had the buckle in her mouth and could have done that even without the tickling. As I assume that she was Borderline, she may have chosen to do many more interesting things with the buckle anyway.

Have your doctors ever added Benadryl IM to the Haldol/Ativan combination? I have seen it work wonderfully with both children and adults. An added bonus with this combination is decreased potential for EPS-especially with kids. Torticollis is an ugly side effect of psych meds with kids, and comes on very quickly with the little ones.

[readysetgo]

Once upon a time while working in the geriatric psych. closed unit I noticed and heard a pt chewing something hard. I said, "What are you chewing."

He said, "A piece of candy." Asked if I could see it and he willingly opened his mouth and took out the so called candy which turned out to be someboby's hearing aid. I wanted to laugh so bad. But instead realized this pt could have swallowed that 'make-believe candy' and what a disaster that would have been. It amazing, the things they do.

[TxPsychRn]

A good ending to a code !! I would worry also about involuntary aspiration with the tickling , and the nose holding is a technique that is commonly used , but a little innovation can be healthy .

[CharlieRN]

Feet tickling does sound pretty clever.

Not to be a monday morning quarterback, but why was it essential to get the buckle away from the client? So she has a buckle in her mouth, so what? All she was threatening to do was swallow it. Generally anything that can go down the esophagus will pass out the orifice.

She could have aspirated it in the struggle. Aspiration can lead to death in minutes. A staff person could have been bitten reaching into her mouth. Human bites are very nasty injuries. The risks involved in getting the foreign object out of the client's mouth seem disproportionate to the risks of letting her play with it. Taking physical control of a person does not generally teach them to take responsiblity for their own behavior, which I would assume is the goal of treatment.

[canoehead, BSN, RN]

I second Charlie. She was looking for attention and got it. If she was threatening to swallow anything that didn't have sharp edges I would be inclined to not worry. Or perhaps to remind her of the pleasures of ipecac and the buckle making a return reverse journey. Probably neither of those interventions would make it anywhere near the hospital's policy book though.