CHEMICAL RESTRAINT

see also Sedation Protocol


Pharmacological Restraint

Several options are available for sedation including neuroleptics (eg Haloperidol), Non-Neuroleptic Antipsychotics (eg Olanzapine, Risperidone) and Benzodiazepines (eg Clonazepam, Midazolam, Lorazepam).

The choice of drug is influenced by the clinical scenario (see Chart of Sedatives and Antipsychotics)

Benzodiazepines are universally given in agitated patients with the addition of antipsychotics and neuroleptics when an acute psychosis or perceptual abnormalities are present.

N.B. in alcohol withdrawal, diazepam is the agent of first choice

N.B. sedation with either midazolam or propofol should not occur without intubation, controlled ventilation and CT head in head injured patients

see Restraint in patient subgroups

Oral / Sublingual Agents

  • Olanzapine Wafer 2.5 mg to 20 mg s/l stat and 4 hourly PRN (max 40 mg/24hours) or
    Risperidone Liquid 0.5mg to 2 mg PO stat and 4 hourly PRN (max 6 mg/24 hours)

and

  • Lorazepam 0.5mg to 5 mg s/l stat and 4 hourly PRN (max 20mg/24 hours)

Parenteral Agents (Intramuscular)

  • Haloperidol 0.5 mg to 10 mg IM stat

(can be repeated @ 60 min up to max 20mg/24hrs)

And

  • Clonazepam 0.5 mg to 4 mg IM stat or
    Midazolam 1 mg to 10 mg IM stat)

(can be repeated @ 30 min)

Parenteral Agents (Intravenous)

  • Haloperidol 0.5 mg to 5 mg IV stat

(can be repeated @ 5-10min up to max 20mg/24hrs)

And

  • Clonazepam 0.5 mg to 1 mg IV stat or
    Midazolam 2.5 mg to 5 mg IV stat)

(can be repeated @ 5-10min)

Benztropine 1-2mg IV/IM should be used in the event of dystonic reactions to haloperidol.

Ensure O2 saturation monitoring and close observations of vital signs.

Following drug administration, the patient must be "specialled" if their GCS is 8 or less. This is to be undertaken by nursing staff member. Vital signs/obs to be completed 15 minutely. Assist with airway protection in the event of vomiting.

Where a mental health patient requires restraining, a detention order must be completed.