Restraint

The behavior that poses any safety risk should be managed before a medical and psychiatric examination can be performed. Indications for emergency sedation and restraint include the prevention of imminent harm to the patient, to others or to the immediate environment. This should be implemented in a systematic manner. Ideally it should follow a predetermined ED protocol that can beimplemented when the examiner leaves the room after simple verbal strategies proveare unsuccessful

Restraint must be carefully applied in any situation, in order to minimise restrictions on chest wall movement, and to assure no negative impact on respiration or other vital functions.

Practical training is recommended. Restraint is a unique problem associated with individuals in an excited state of delirium. Once again, care needs to be taken in order to avoid interference with vital body functions.

Excited Delirium

In this state, an individual displays bizarre and aggressive behaviour, often associated with drug abuse Example. Such behaviour may involve cocaine or amphetamines

The subjects may feel no pain, are abnormally strong and oftentend to rip away their clothings.

They are frequently brought into the hospital ED by the police.

These people are at great risk because they are:

• hyper-pyrexial
• dehydrated
• acidotic
• hypoglycaemic
• fatigued

It is essential to rapidly intervene to prevent physical or mental deterioration; Hence, restraint and rapid tranquillizing will be needed, in order to facilitate immediate treatment.