the agitated patient: protecting yourself and the patient

Agitation in ICUBy Dr Minh Le Cong

Royal Flying Doctor Service, Queensland

Prevention?

Haloperidol prophylaxis

Kalisvaart, JAGS 2005;53:1658-1666

Haloperidol and mortality

DEXMEDETOMIDINE VS. HALOPERIDOL IN DELIRIOUS, AGITATED, INTUBATED PATIENTS: A RANDOMISED OPEN-LABEL TRIALMICHAEL C READE*, KIM O'SULLIVAN, SAMANTHA BATES, DONNA GOLDSMITH, WILLIAM RSTJ AINSLIE AND RINALDO BELLOMOCRIT CARE 2009

Less delirium, more bradycardia

Check out www.emcrit.org

11

What would you prepare and how would you give it?

13

Use a sedation score

14

16

ON ketamine 80mg/hr

17

Ketamine for agitation ?? Are you nuts?

Growing research into ketamine in mental health

Rapid antidepressant Rapid Anti suicidal effect Can ameliorate/resolve PTSD

References http://images.fineartamerica.com/images-medium/mental-agitation-paulo-zerbato.jp

g http://www.google.com.au/imgres?imgurl=http://wpmedia.blogs.theprovince.com/20

12/09/icu2.jpg&imgrefurl=http://blogs.theprovince.com/2012/09/25/letters-end-of-life-icu-christy-clark-b-c-conservatives-food-labels-mp-costs-bike-lanes-police/&h=377&w=640&sz=90&tbnid=szFE3EPfjrA7gM:&tbnh=92&tbnw=156&zoom=1&usg=__jEPztWVntCwKHKlLG-enXTcZLr4=&docid=fRKRotkyBM4wTM&sa=X&ei=wcYeUoSpCquaiQeiyYDoBQ&ved=0CGkQ9QEwEg&dur=204

http://www.slideshare.net/hospira2010/patients-gone-wild-agitation-and-delirium-in-the-icu

http://www.goodrx.com/haloperidol/images#imgModal http://emcrit.org/podcasts/human-bondage-chemical-takedown/ http://media.photobucket.com/user/death_to_amerika/media/fight_club.jpg.html?

filters[term]=fight%20club&filters[primary]=images&filters[secondary]=videos&sort=1&o=8

http://www.mmafighting.com/2013/8/28/4669374/ufc-fight-night-27-photos http://i2.listal.com/image/1164347/600full-the-strangler-of-blackmoor-castle-

poster.jpg http://www.matilda.aktivix.org/collectives/ketamine/myths/1-horse-tranquilliser/

horse-tranquilliser.jpg http://www.webmd.com/drugs/drug-1596-droperidol+Inj.aspx?

drugid=1596&drugname=droperidol+Inj&pagenumber=2 http://www.forbes.com/sites/matthewherper/2013/05/23/johnson-johnson-is-

reinventing-the-party-drug-ketamine-to-treat-depression/