A local BASICS colleague and I have come in for some unwanted critiscism:
"unwise" critiscism I hope.
The critiscism involves our decision on 2 seperate occasions to sedate 2
seperate patients behaving violently and aggresively with ambulance staff
having both been involved in high speed RTA's.
In both cases there was no immediately obvious injuries, suggestion of
pre-existing intoxication or medical problems.Our working diagnoses were of
cerebral irritation .
In line of we what both believed at the time was reasonable practice we
opted to sedate the patients with IV midazolam titrated to response to allow
safe airway management, oxygenation and more practically safe transport to
A&E.
Dr C John Eatons book "essentials of pre-hospital Immediate Medical Care"
offers us support in our actions from the point of view of correction of
hypoxia and prevention of exacerbating raised intracranial pressure through
hypercapnia.
The critiscism was voiced by a local A&E colleague with little pre-hospital
experience .We would both feel happier answering her crtiscism backed by
further evidence based material or guidelines.
Can the list help?
Dr Mark Nettleton MBBS MRCGP DGM Dip IMC RCS Ed
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