Using Restraints to Manage Agitated Patients

Using Restraints to Manage Agitated Patients

Most emergency physicians think of agitation as relatively simple to treat, with sedation being the most common course of action. However, sedating even just a few agitated patients in precious ED beds can increase waiting times for the entire ED. Further complicating matters is that all agitation is not the same. Use of restraints is sometimes necessary, but decisions to use them are often made without thinking of the ramifications. “Use of restraints is sometimes necessary, but decisions to use them are often made without thinking of the ramifications.” The key advantages to restraining agitated patients are that it protects staff from violence from patients and facilitates intramuscular (IM) delivery of calming medications. On the other hand, improperly applied restraints may injure patients. In addition, most injuries to staff probably occur during the restraint process. Physicians should be mindful that restraints don’t allow patients to participate fully in their care. Appropriate Use of Restraints Among Agitated Patients Restraints should be applied either in the upper extremities only or on the upper and lower extremities with minimal force,which usually requires assistance from others in the ED. Every attempt should be made to avoid standing or sitting on patients during application. If weight force is needed, it should be applied as briefly as possible with careful monitoring of ventilatory status. Although many physicians wish to stand aside during the forceful takedown of patients, physician presence during takedowns may reassure staff and patients that these procedures will be done as gently as possible. Emergency physicians, however, should only partake in takedowns if they’ve been trained to do so.   In most cases,...

Hand Sanitizer Use & Breathalyzer Results

Breathalyzer machines are commonly used in the ED to help clinicians and law enforcement officials determine the degree to which patients are intoxicated with alcohol, with the legal limit being 0.080 g/dL. Most commercially available hand sanitizers contain ethyl alcohol, but studies suggest that these products don’t significantly elevate blood alcohol levels in individuals who have applied them to themselves, even when applied excessively. What remains unclear, however, is whether applying hand-sanitizer mixtures to people measuring breathalyzer levels could falsely elevate breathalyzer results of patients whose alcohol level is being measured. There is reason to suspect that it might because alcohol is volatile and, thus, may distort breathalyzer readings. “Patients who are improperly assumed to be intoxicated may be held longer than necessary in the ED, resulting in crowding and longer wait times for other patients.” Hand Sanitizer’s Effect on Breathalyzers In a study published in Academic Emergency Medicine, my colleagues and I sought to determine if applying alcohol-based hand sanitizer on the hands of people holding a breathalyzer affected readings of others. The initial breathalyzer readings of all study participants were 0.000 g/dL. We found that some common alcohol-based hand sanitizers may affect breathalyzer readings when used improperly, presumably by vaporization of the hand sanitizer on the part of the person holding the breathalyzer. This in turn affected the readings in patients who had not ingested alcohol. The breathalyzer readings were further elevated if more sanitizer was used or if it wasn’t allowed to dry appropriately. According to the results, the median breathalyzer reading was 0.119 g/dL in the group who used two pumps (3 mL) without allowing...