- Title
- Sedation of acute behaviour disturbance
- Creator
- Calver, Leonie Anne
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The pharmacological treatment of patients with acute behavioural disturbance (ABD) is difficult and there is little consensus of best clinical practise, which is often based on anecdote and historical practice. Multiple doses of medication and combination therapy are common and often leads to higher total doses being administered or rapid development of tolerance making sedation difficult. The choice of agent remains controversial, but recent studies indicate that droperidol is as effective as benzodiazepines. However, the cardiac safety of droperidol has been questioned. The goal of this thesis was to investigate the benefit of using a standardised sedation protocol with a simple assessment tool for reporting agitation and sedation and used a single agent droperidol for sedation. This included studying ABD in a large cohort of emergency department patients, including a subgroup of elderly patients, and acute mental health patients. The principle findings of the thesis were: 1. The sedation-agitation tool is a simple, rapid and useful measure of level of agitation/sedation in patients with ABD. ; 2. In a pilot study intravenous dexmedetomidine for difficult to sedate patients with ABD was not safe in the emergency department. ; 3. In a cohort of 46 patients who had continuous holtor monitoring following droperidol for ABD, QT prolongation was detected in four patients and there was little evidence to support droperidol being the cause. ; 4. Droperidol was effective for sedation in most elderly patients with ABD and adverse effects were uncommon. An initial 5mg dose appears prudent with the expectation that many will require another. ; 5. In a cohort of over 1000 emergency department patients with ABD, droperidol effectively sedated over 90% with one or two doses, there were no arrhythmias and only 1% had an abnormal QT, supporting the safety of high dose droperidol. ; 6. In acute mental health patients large initial doses of sedation were used for ABD in over 50%, and additional sedation was rare. Higher dose sedation didn’t result in more rapid or effective sedation but was associated with adverse effects. ; 7. A controlled trial of droperidol versus haloperidol in a psychiatric intensive care unit found both equally effective for sedation of patients with ABD.
- Subject
- violence; sedation; emergency department; aggression; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1310119
- Identifier
- uon:21985
- Rights
- Copyright 2015 Leonie Anne Calver
- Language
- eng
- Full Text
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| View Details Download | ATTACHMENT02 | Thesis | 7 MB | Adobe Acrobat PDF | View Details Download |