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It's Stinky time!
Temporary control : Grasping and exerting the instrument over the edge of the skin . the galea and the dermis with a hemostat and exerting the instrument over the edge of the skin: Clinical Procedures in Emergency Medicine 6th edition Roberts and Hedges p 680 fig 35-51.Disadvantage tissue grasped by hemostat can be crushed and devitalised .Provides temporarisation for PanicDid it once in GP practice -worked for a temporary hemostasis .
The best trick I learnt to get rid of the stink.... Squirting Insulin (Actrapid usually) in the air, on the curtains, walls, sheets around the patient.Works.... A..... Treat!Trust me...... It'll change your life.Just don't spray so much that you all have hypo's
Strayer mentioned that there is good evidence now that neuroleptics and ketamine are safe in the undifferentiated agitation patient. I would love to forward this. Can you link some references?
Here are a slew of them:
Regarding your May intro discussion "The Cure for Stink," I will share a tip from the Grand Canyon river trips where you must carry the "groover" (20 mm metal ammo cans 17x14x7 inches = 1.54 cubic feet) full of excrement, in 100 degree weather, from the toilet site back to the rafts. Especially when full, the aroma can be quite overwhelming. Place one Altoid mint tablet in each nostril. The pleasant peppermint aroma quiets the stench quite nicely. It works in the ER as other ventilation methods (like discharging the stinky feet) are put in play.Ed Heneveld
As sodium bicarb is on national shortage so terribly they are emergency importing from Australia..... If you order an amp of Bicarb for stinky feet don't surprised if your Pharmacy buyer collapses. Please use alternatives until Q2 2018.
MIKE HERRERA, AUGUST 2017-I HAVE SOME DISAGREEMENTS WITH THE MANAGEMENT OF AGITATED DELIRIUM AS PER DR REUBEN STRAYER-TO ME THE CRUCIAL POINT IS QUICK CONTROL-FORCEFULL ALL LIMB RESTRAIN AND PARALYSIS IS CRUCIAL-ANY VEIN ANYWHERE OR INTROOSSEOUS AND PARALIZE WITH SUX OR ROC, AND HYPERVENTILATE, WHILE OTHER IV SITES ARE OBTAINED AND INTUBATE ASAP-BENZOS AND FENTANYL-HYPERVENTILATE AND BICARBONATE TO COMBAT THE EXTREME METABOLIC ACIDOSIS-THIS PEOPLE EXPIRE FROM VENTRICULARARRHYTHMIAS DUE TO EXTREME ACIDOSIS CAUSED BY MUSCLE DESTRUCTION FROM THE HYPERACTIVITY-I USUALLY USE SUX, BUT THEORETICALLY PERHAPS ROC OR VEC ARE BETTER, BEING NON DEPOLARIZING AND CONTRIBUTING TO EXTRA MUSCLE CONTRACTION- I DISAGREE WITH THE USE OF HALDOL OR ANY PHEHOTHIAZINES, THIS PATIENTS ARE OFTEN HYPERTHERMIC OR AT RISK OF IT, AND PHENOTHIAZINES WILL BLOCK THE HYPOTHALAMIC THERMOREGULATORY CENTER LEADING TO MALIGNANT HYPERTHERMIA-THIS ARE JUST MY PERSONAL THOUGHTS , NOT MUCH LITERATURE ON THE SUBJECT-M. HERRERA, MD, FAAEM, HOMESTEAD FLORIDA
Rub a line of Mentholatum or Vaporub ointment underneath the nose. This is an easy and proven trick for EMS/police/Fire in the field. Works well. Try it.
What you do matters.