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