"What are the steps of the agitation study?"
Click here to
view flow chart
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"Who is eligible for the agitation study?"
Patients who will be receiving sedation for acute agitation.
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"Who is not eligible for the agitation study?"
Patients who are pregnant, mentally handicapped, prisoners, or patients who
have allergies to the study drugs.
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"How do I find agitated patients?"
Agitated patients can be anywhere in the department, but most often are
found in Special Care and Team Center A. Most often these patients
come to the ED with a chief complaint of acute alcohol intoxication.
Any patient in Special Care should be considered for the agitation study.
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"What is the AMSS score?"
The AMSS score is a number from -4 to +4 that represents the patient's
mental status. Click here to view.
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"What is the BARS score?"
The BARS score is a number from 1 - 5 that represents the patient's
mental status. Click here to view.
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"How do I assign the AMSS and BARS scores?"
To use either scale, begin by assuming that the patient is alert and
sober, i.e. "normal". Each scale is designed to assess the patient
primarily on their responsiveness. Responsiveness is intended to be
judged by the patient's response to different stimuli. In order to
assign the score for sedated patients, you must begin by speaking the
patient's name in a normal tone, then move to shouting, and finally to
shaking to patient. The stimulus which elicits the response is used to
assign the AMSS/BARS score. For agitated patients, their speech (ie
whether or not they are shouting) and their facial expression can be used to
differentiate among scores.
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"Where can I find a pulse oximetry monitor?"
Pulse oximeters are most easily found by asking an HCA (maroon scrubs)
if they know the location of one.
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"When do I need to get a rhythm strip?"
You should obtain a rhythm strip 30 minutes after sedation is effective.
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"How do I obtain a rhythm strip?"
Click here to view instructions.
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"What can I do to stay safe?"
Do not approach a patient who is not in restraints. When entering
patients in a study wear gloves and a face shield. Do not approach
patients until you are given permission to do so by the patient's
caretakers.
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"What if a patient is threatening me?"
If you feel like are in a threatening situation, ask a nurse or HCA to
assist you in data collection. You should also ask the security guards
to accompany you to the patient's bedside.
BMI:
"Who is eligible for the study?"
Any patient who will receive an IV during their stay in the ED is
eligible provided they have not yet received it.
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"Can I do the study after the IV has already been placed?"
No. The patient's background pain must be obtained before the
IV is placed.
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"How do I take the body caliper measurements?"
Click here to view instructions.
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"Where can I find a scale to weigh and measure the patients?"
The scale is located in TCC in front of C6.
Etomidate vs. Propofol:
Q. "Who is eligible for the Etomidate vs. Propofol study?"
A. Any patient who is > 18 years old and is undergoing procedural sedation
for any reason is eligible.
Q.
"Can I still collect data if the BIS monitor is not working?"
A. Yes. As long ETCO2
and vitals can be obtained, the study can still be
done.
Q.
"Can I still collect data if the ETCO2
monitor is not working?"
A. No. ETCO2
is the primary end-point of the study.
Q. "How often do I collect vitals information during the study?"
A. Data should be collected every minute.
Q.
"What values of the BIS and ETCO2
should be recorded?"
A. The lowest values observed
for both the BIS and ETCO2
during each one minute interval should be recorded.
Q.
"How do I interpret the ETCO2
waveform to assign the 1 - 4 score?"
A.
Click here for an illustrated example.
Q.
"How long do I need to observe the patient after the procedure?"
A. The patient should be observed until he/she returns to
his/her baseline mental status. The beginning and end of a
procedure should be indicated on the data sheet.
Q.
"When should I ask the patient the post-procedural questions?"
A. The patient should be asked the questions after he/she has
returned to baseline mental status as assessed by BIS and your
observation of their behavior. |
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