Phyllis,
After
trying every possible way we knew, we have found that if a family member cannot
stay with the patient, minimal doses of Propofol, Midazolam, and soft
restraints work the best on our agitated head injury patients. We only use
enough Propofol to prevent them from injuring themselves and that dose is
clearly patient specific. Usually the family member has minimal involvement
unless you can see an obvious positive response from the patient but the family
member can see how difficult it is to manage their loved one and this is very
important in other ways. The neurologists usually call or have certain times
they make rounds and ask that we shut the Propofol off about ½ an hour before
they arrive so they can assess the patients status. Frequent attempts are made
to decrease the Propofol and balance with increased Midazolam until eventually
you can get everything off. Hope this helps.
Tony
Mitchell RN, CCRN,
Trauma Coordinator
St. John's Regional
Medical Center
Joplin, Missouri,
64804
Office- 417-627-8337
Pager- 888-665-1827
email-
tmitchel@stj.com
-----Original
Message-----
From: Uribe Phyllis
[mailto:Phyllis.Uribe@HealthONEcares.com]
Sent: Friday, June 13, 2003 3:09 PM
To:
'traumanurses@mailman.listserve.com'
Subject: [traumanurses] Need some
help with agitated neurotrauma patients
Greetings, all. As you
head off into your weekend, our neurotrauma unit is looking for some creative
ideas on how to assure safety for agitated brain injured patients. They often
request an order for a "sitter" or "behavioral attendant"
to stay with the patient, but staffing and budget constraints mean that is not
always available. Any ideas you have used or policies for deciding between
drugs, restraints, and attendants would be welcomed. Thank you in advance.
Phyllis
Uribe RN BSN CCRN
Trauma Program Supervisor
303-788-5082 (office)
303-788-6928 (FAX)
Phyllis.Uribe@HealthONEcares.com
www.swedishhospital.com