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I know
staffing is tough but sitters do seem the way to go. We've had more than one
meeting on that topic! It's pretty non-therapeutic to restrain the TBI pt. Then
again, so is having them get hurt!
We try
to get their day/night patterns set. Trazadone at hs, and we use Risperdal quite
a bit too and find it very effective for the restlessness. The pts seem to
do real good with those 2 in combo, I've seen some pretty dramatic behavior changes. We have a wonderful physiatrist on staff, I imagine you do too. Talk to
him or her if you haven't already.
Cynthia Arpin, R.N.
Trauma Program Manager
W.W. Backus
Hospital
326 Washington Street
Norwich, C.T. 06360
(860)889-8331 ext. 3220
FAX (860)892-2798
Thanks, Tony. We, too, love Propofol. However, I should have been
clearer that the patients I seek ideas for have been transferred out of critical care and are not in monitored beds....our neurotrauma unit is a step-down type of unit for patients with brain and spinal cord
injuries.
Phyllis Uribe
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
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