My mistake. I should have asked where these patients were. Obviously
propofol is not approved in this environment. I had a case of critical care tunnel vision…
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 3:39
PM
To:
'traumanurses@mailman.listserve.com'
Subject: [traumanurses] Re: Need
some help with agitated neurotrauma p atie nts
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
-----Original Message-----
From: Mitchell, Tony
[mailto:tmitchel@stj.com]
Sent: Friday, June 13, 2003 2:35
PM
To:
'traumanurses@mailman.listserve.com'
Subject: [traumanurses] Re: Need
some help with agitated neurotrauma patie nts
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