social intubation?

Specialties Emergency

Published

Note : I am not a nurse, but a medic but have worked in level one trauma center in that capacity

I was reading a post in another site and it brought up a valid question in my mind from when I worked in ER. I saw many patients intubated (RSI) for the convenience of the physician and staff if they were obnoxious. This included drunks and just downright difficult people sometimes with relatively minor problems. More than once I heard the comment "settle down or I'll put you down !" and it was done. What is your experiences with this and how do you feel about it? Do you ever question the docs when they do this or is it appreciated? I'll be the first to admit, yes, it did make them easier to manage, but tied up space in the ER longer and usually made them end up being admitted overnight for observation. I'm just curious if anyone else questioned that judgement call. Doing ground CCT transport in a rural area now, it's used alot for transports due to 2 hours plus sometimes to trauma center with no ability to fly 'em and I'm not going to manage a difficult patient for 2 hours by myself, but just for convenience in the ER? I'm not seeing much of a need for this and wondered if it was prevelant in other areas or just in that particular ER. Thanks !:banghead:

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Specializes in Nephrology, Cardiology, ER, ICU.

In 10 years in level one trauma center, only seen it done once: guys was drunk and high on PCP! We simply couldn't control him....did he medically need intubation? Nope! However, he was a danger to himself and us so down he went. Never saw or heard of it done again.

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Specializes in EMS, ER, GI, PCU/Telemetry.

i also worked as a medic in a level 1, and ive seen this done many times. the docs i primarily worked with actually preferred it if the patient was out of control, rather than trying the regular B52 or HAM combination, they would pull out the big guns. yes, sometimes it was medically necessary, if the patient was severely hypoxic and combative, but most other times it was a etoh/meth nightmare that was verbally and physically too strong to restrain and normal sedatives did not work.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

I've seen it as well; meth and out of control, harmful to self and/or others. But, that's the only times.

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Specializes in Critical Care.
i also worked as a medic in a level 1, and ive seen this done many times. the docs i primarily worked with actually preferred it if the patient was out of control, rather than trying the regular B52 or HAM combination, they would pull out the big guns. yes, sometimes it was medically necessary, if the patient was severely hypoxic and combative, but most other times it was a etoh/meth nightmare that was verbally and physically too strong to restrain and normal sedatives did not work.

I figured out "HAM", but what is "B52"?

Thanks.

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Specializes in EMS, ER, GI, PCU/Telemetry.

the B-52 bomber... 50mg benadryl, 2mg ativan, 5mg haldol

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I once had a trauma transfer pt who had to be intubated because he couldn't tolerate being placed on the backboard. He had been hit in the head ( I don't remember with what) but was completely stable when we arrived; A/Ox3 ,no distress, stable v/s , cooperative. I don't remember if he had a bleed or not. We explained what we were going to have to do in regards to boarding and collaring him and he seemed to be OK with it. He changed his tune pretty quick when it came time to actually place him on the board though. He just started screaming and fighting and he had that panicked animal type look in his eyes . It was a bizarre transformation. It took 4-5 people to hold him down and we all were taking turns trying to explain to him what we were doing and why but he just didn't seem to be processing anything we were telling him . After a couple minutes of this it was decided that we were just going to have to tube him. It was an unfortunate thing but in this case it was more or less indicated.

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Note : I am not a nurse, but a medic but have worked in level one trauma center in that capacity

I was reading a post in another site and it brought up a valid question in my mind from when I worked in ER. I saw many patients intubated (RSI) for the convenience of the physician and staff if they were obnoxious. This included drunks and just downright difficult people sometimes with relatively minor problems. More than once I heard the comment "settle down or I'll put you down !" and it was done. What is your experiences with this and how do you feel about it? Do you ever question the docs when they do this or is it appreciated? I'll be the first to admit, yes, it did make them easier to manage, but tied up space in the ER longer and usually made them end up being admitted overnight for observation. I'm just curious if anyone else questioned that judgement call. Doing ground CCT transport in a rural area now, it's used alot for transports due to 2 hours plus sometimes to trauma center with no ability to fly 'em and I'm not going to manage a difficult patient for 2 hours by myself, but just for convenience in the ER? I'm not seeing much of a need for this and wondered if it was prevelant in other areas or just in that particular ER. Thanks !:banghead:

RU collecting info for a newspaper article or something along that line?
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Specializes in ICU.

so, what is HAM? :)

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RU collecting info for a newspaper article or something along that line?

I bet he read one of the threads on flightweb. Sometimes you need to "put the patient down" for the safety of the staff and the patient. I have taken care of a few meth/cocaine/pcp patients where we performed a RSI simply to control a dangerous situation. I see no problem with going down this road when less aggressive interventions will not work or cannot be performed.

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Specializes in Critical Care.
so, what is HAM? :)

My guess is "Haldol, Ativan, and Morphine".

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Specializes in Cardiac, ER.

To the OP,..I assure you it's not "convienient" for me to RSI someone. If your rude, violent and all around nasty,.I prefer to get you medically cleared and out of my ER!!

Now,.if your out of control and I have reason to think you are actually injured,.ie the meth head who was just hit by a car or the "found on the side of the road covered in blood" OR you are so out of control that your are harming yourself and those around you (me),.I will try all the usual remedies to calm you down. If the amount of sedation it takes to get you under control will jepordize your ability to breathe on your own,.then it becomes medically necessary to RSI you.

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