Contemplating life.

Going Nuts

I have recently discovered the joy of having a decent sized container of mixed nuts with me in the ambulance. Great for on-the-go nibbles.

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What I was really going to talk about was more about patients behaving badly. I haven’t come across such a patient in a while now (can’t remember when I had to sedate someone last), but it does happen. And I’ve come across this topic on the web recently.

EMS Outside Agitator has a link to an interesting vid. Go have a look, possibly a chuckle, and then a thought or three how you would have handled the situation if you were first on scene. I know I would have called for police quicksmart, and strongly considered sedation. Not sure about the whole backboard though…your thoughts?

Rogue Medic wishes us a Happy Excited Delirium on his take on the above post. Interesting and edgy, as always.

And last but definitely not least, EMCrit talks about Human Bondage and the Art of Chemical Takedown. Brilliant podcast, listen to this episode – much of the stuff he talks about can be adapted to the world of out-of-hospital care too.

Note on the side: I hear and read that UK Paramedics can’t chemically restrain patients – there is no mention of it on the JRCALC website, couldn’t find anything under ‘Mental Disorders‘. Midazolam or Haloperidol/Droperidol is not part of their drug regime, and Diazepam is only indicated for seizure activity and symptomatic cocaine toxicity – no mention of sedation.

Any UK paramedics (that includes EMTS and everyone else) that would like to chime in?

May your shift be a good one…


Jack Buckle says:

That’s true. UK paramedics can not chemically restrain paramedics. Although critical care para’s can sedate agitated patients.
We have BASIC’s Doctors and nurses that can sedate patients as required.

P says:

We can request HEMS or a BASICs Dr to come and sedate a patient, but we don’t have anything where we can do it ourselves.

Unles you count an oxygen cylinder, but clouting the patient round the head with one isn’t indicated either.

Adders says:

Haloperidol for psychosis and midazolam for sedation is only incidicated in the intensive care paramedic skillset in Queensland.

I have only ever seen a patient sedated once and that was after he was restrained by police anyway. So far (touch wood), I have never wanted a patient that I was treating sedated — police restraint has proven effective, without the side effects of chemical restraint.

trig says:

Not strictly true in respect of Diazemuls. If you take a look at the overdose section of the JRCALC guidelines in specific treatment options, illegal drugs, diazepam can be used to sedate LSD, amphetimine, ecstasy etc patients. I’ve queried this as it doesn’t state it in the drug section but had it confirmed by one of the DRs from JRCALC. Although he did say it was preferable to liase with the ED however it is permissible. That was back in 2007. I’ve used it in this situation.

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