A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unit
Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint and involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical practice is often guided by experience and there is little agreement on which drug...
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| Veröffentlicht in: | BMC psychiatry 2013-09, Vol.13 (1), p.225-225, Article 225 |
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| description | Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint and involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical practice is often guided by experience and there is little agreement on which drugs should be first-line treatment for rapid tranquilisation. This study aimed to investigate sedation for ABD in an acute mental healthcare unit, including the effectiveness and safety of high dose sedation.
A prospective study of parenteral sedation for ABD in mental health patients was conducted from July 2010 to June 2011. Drug administration (type, dose, additional doses), time to sedation, vital signs and adverse effects were recorded. High dose parenteral sedation was defined as greater than the equivalent of 10 mg midazolam, droperidol or haloperidol (alone or in combination), compared to patients receiving 10 mg or less (normal dose). Effective sedation was defined as a fall in the sedation assessment tool score by two or a score of zero or less. Outcomes included frequency of adverse drug effects, time to sedation/tranquilisation and use of additional sedation.
Parenteral sedation was given in 171 cases. A single drug was given in 96 (56%), including droperidol (74), midazolam (19) and haloperidol (3). Effective sedation occurred in 157 patients (92%), and the median time to sedation was 20 min (Range: 5 to 100 min). The median time to sedation for 93 patients receiving high dose sedation was 20 min (5-90 min) compared to 20 min (5-100 min; p = 0.92) for 78 patients receiving normal dose sedation. Adverse effects occurred in 16 patients (9%); hypotension (14), oxygen desaturation (1), hypotension and oxygen desaturation (1). There were more adverse effects in the high dose sedation group compared to the normal dose group [11/93 (12%) vs. 5/78 (6%); p = 0.3]. Additional sedation was given in 9 of 171 patients (5%), seven in the high dose and two in the normal dose groups.
Large initial doses of sedative drugs were used for ABD in just over half of cases and additional sedation was uncommon. High dose sedation did not result in more rapid or effective sedation but was associated with more adverse effects. |
| doi_str_mv | 10.1186/1471-244X-13-225 |
| format | Article |
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A prospective study of parenteral sedation for ABD in mental health patients was conducted from July 2010 to June 2011. Drug administration (type, dose, additional doses), time to sedation, vital signs and adverse effects were recorded. High dose parenteral sedation was defined as greater than the equivalent of 10 mg midazolam, droperidol or haloperidol (alone or in combination), compared to patients receiving 10 mg or less (normal dose). Effective sedation was defined as a fall in the sedation assessment tool score by two or a score of zero or less. Outcomes included frequency of adverse drug effects, time to sedation/tranquilisation and use of additional sedation.
Parenteral sedation was given in 171 cases. A single drug was given in 96 (56%), including droperidol (74), midazolam (19) and haloperidol (3). Effective sedation occurred in 157 patients (92%), and the median time to sedation was 20 min (Range: 5 to 100 min). The median time to sedation for 93 patients receiving high dose sedation was 20 min (5-90 min) compared to 20 min (5-100 min; p = 0.92) for 78 patients receiving normal dose sedation. Adverse effects occurred in 16 patients (9%); hypotension (14), oxygen desaturation (1), hypotension and oxygen desaturation (1). There were more adverse effects in the high dose sedation group compared to the normal dose group [11/93 (12%) vs. 5/78 (6%); p = 0.3]. Additional sedation was given in 9 of 171 patients (5%), seven in the high dose and two in the normal dose groups.
Large initial doses of sedative drugs were used for ABD in just over half of cases and additional sedation was uncommon. High dose sedation did not result in more rapid or effective sedation but was associated with more adverse effects.</description><identifier>ISSN: 1471-244X</identifier><identifier>EISSN: 1471-244X</identifier><identifier>DOI: 10.1186/1471-244X-13-225</identifier><identifier>PMID: 24044673</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Anesthesia ; Antipsychotics ; Blood pressure ; Clinical medicine ; Clinical practice guidelines ; Dosage and administration ; Droperidol - administration & dosage ; Droperidol - adverse effects ; Droperidol - therapeutic use ; Drug dosages ; Drug Therapy, Combination ; Emergency medical care ; Female ; Haloperidol ; Haloperidol - administration & dosage ; Haloperidol - adverse effects ; Haloperidol - therapeutic use ; Humans ; Hypnotics and Sedatives - administration & dosage ; Hypnotics and Sedatives - adverse effects ; Hypnotics and Sedatives - therapeutic use ; Immobilization - methods ; Male ; Medical records ; Mental Disorders - drug therapy ; Mental health ; Midazolam - administration & dosage ; Midazolam - adverse effects ; Midazolam - therapeutic use ; Middle Aged ; Oxygen saturation ; Patients ; Physical restraints ; Prospective Studies ; Psychiatric Department, Hospital ; Psychiatry ; Psychopharmacology ; Psychotropic drugs ; SAT assessment ; Time Factors ; Treatment Outcome ; Violence ; Vital signs</subject><ispartof>BMC psychiatry, 2013-09, Vol.13 (1), p.225-225, Article 225</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Calver et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Calver et al.; licensee BioMed Central Ltd. 2013 Calver et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b584t-ea92e076fd74cc5286745f92c79374dfb0a5c19fc3f0cc08d1e1262c3b426b413</citedby><cites>FETCH-LOGICAL-b584t-ea92e076fd74cc5286745f92c79374dfb0a5c19fc3f0cc08d1e1262c3b426b413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848824/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848824/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,27911,27912,53778,53780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24044673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calver, Leonie</creatorcontrib><creatorcontrib>Drinkwater, Vincent</creatorcontrib><creatorcontrib>Isbister, Geoffrey K</creatorcontrib><title>A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unit</title><title>BMC psychiatry</title><addtitle>BMC Psychiatry</addtitle><description>Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint and involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical practice is often guided by experience and there is little agreement on which drugs should be first-line treatment for rapid tranquilisation. This study aimed to investigate sedation for ABD in an acute mental healthcare unit, including the effectiveness and safety of high dose sedation.
A prospective study of parenteral sedation for ABD in mental health patients was conducted from July 2010 to June 2011. Drug administration (type, dose, additional doses), time to sedation, vital signs and adverse effects were recorded. High dose parenteral sedation was defined as greater than the equivalent of 10 mg midazolam, droperidol or haloperidol (alone or in combination), compared to patients receiving 10 mg or less (normal dose). Effective sedation was defined as a fall in the sedation assessment tool score by two or a score of zero or less. Outcomes included frequency of adverse drug effects, time to sedation/tranquilisation and use of additional sedation.
Parenteral sedation was given in 171 cases. A single drug was given in 96 (56%), including droperidol (74), midazolam (19) and haloperidol (3). Effective sedation occurred in 157 patients (92%), and the median time to sedation was 20 min (Range: 5 to 100 min). The median time to sedation for 93 patients receiving high dose sedation was 20 min (5-90 min) compared to 20 min (5-100 min; p = 0.92) for 78 patients receiving normal dose sedation. Adverse effects occurred in 16 patients (9%); hypotension (14), oxygen desaturation (1), hypotension and oxygen desaturation (1). There were more adverse effects in the high dose sedation group compared to the normal dose group [11/93 (12%) vs. 5/78 (6%); p = 0.3]. Additional sedation was given in 9 of 171 patients (5%), seven in the high dose and two in the normal dose groups.
Large initial doses of sedative drugs were used for ABD in just over half of cases and additional sedation was uncommon. High dose sedation did not result in more rapid or effective sedation but was associated with more adverse effects.</description><subject>Adult</subject><subject>Anesthesia</subject><subject>Antipsychotics</subject><subject>Blood pressure</subject><subject>Clinical medicine</subject><subject>Clinical practice guidelines</subject><subject>Dosage and administration</subject><subject>Droperidol - administration & dosage</subject><subject>Droperidol - adverse effects</subject><subject>Droperidol - therapeutic use</subject><subject>Drug dosages</subject><subject>Drug Therapy, Combination</subject><subject>Emergency medical care</subject><subject>Female</subject><subject>Haloperidol</subject><subject>Haloperidol - administration & dosage</subject><subject>Haloperidol - adverse effects</subject><subject>Haloperidol - therapeutic use</subject><subject>Humans</subject><subject>Hypnotics and Sedatives - administration & dosage</subject><subject>Hypnotics and Sedatives - adverse effects</subject><subject>Hypnotics and Sedatives - therapeutic use</subject><subject>Immobilization - methods</subject><subject>Male</subject><subject>Medical records</subject><subject>Mental Disorders - drug therapy</subject><subject>Mental health</subject><subject>Midazolam - administration & dosage</subject><subject>Midazolam - adverse effects</subject><subject>Midazolam - therapeutic use</subject><subject>Middle Aged</subject><subject>Oxygen saturation</subject><subject>Patients</subject><subject>Physical restraints</subject><subject>Prospective Studies</subject><subject>Psychiatric Department, Hospital</subject><subject>Psychiatry</subject><subject>Psychopharmacology</subject><subject>Psychotropic drugs</subject><subject>SAT assessment</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Violence</subject><subject>Vital signs</subject><issn>1471-244X</issn><issn>1471-244X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1Uk1rFDEYHkSxtXr3JAEvXqbma5KZi7AsagsFLwreQiYfOykzyTbJLPTcP26GXZddqeSQ8D7P--R5P6rqPYLXCLXsM6Ic1ZjS3zUiNcbNi-ryGHp58r6o3qR0DyHibYNeVxeYQkoZJ5fV0wpsY0hbo7LbGZDyrB9BsGBwmwHokErIaJld8MCGCKLcOg1ylP5hdqNLe6TwpZqzAb0Z5M6FOcoRaFfEYi-9MsB5IP2BMxmfCzwYOeYBzN7lt9UrK8dk3h3uq-rXt68_1zf13Y_vt-vVXd03Lc21kR02kDOrOVWqwS3jtLEdVrwjnGrbQ9ko1FlFLFQKthoZhBlWpKeY9RSRq-rLXnc795PRqhgpRsU2uknGRxGkE-eId4PYhJ0gLW1bTIvAei_Qu_AfgXNEhUksQxDLEAQiosyoqHw62IjhYTYpi8klZcZRehPmVBIoIYwztjj--A_1vjTXlyYVFuEQdRyfsDZyNMJ5G8rnahEVq4ZQhjradIV1_QyrHG0mp4I31pX4WQLcJ6iyICkaeywUQbGs33OlfTjt8DHh776RP5j715A</recordid><startdate>20130918</startdate><enddate>20130918</enddate><creator>Calver, Leonie</creator><creator>Drinkwater, Vincent</creator><creator>Isbister, Geoffrey K</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>5PM</scope></search><sort><creationdate>20130918</creationdate><title>A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unit</title><author>Calver, Leonie ; Drinkwater, Vincent ; Isbister, Geoffrey K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b584t-ea92e076fd74cc5286745f92c79374dfb0a5c19fc3f0cc08d1e1262c3b426b413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Anesthesia</topic><topic>Antipsychotics</topic><topic>Blood pressure</topic><topic>Clinical medicine</topic><topic>Clinical practice guidelines</topic><topic>Dosage and administration</topic><topic>Droperidol - administration & dosage</topic><topic>Droperidol - adverse effects</topic><topic>Droperidol - therapeutic use</topic><topic>Drug dosages</topic><topic>Drug Therapy, Combination</topic><topic>Emergency medical care</topic><topic>Female</topic><topic>Haloperidol</topic><topic>Haloperidol - administration & dosage</topic><topic>Haloperidol - adverse effects</topic><topic>Haloperidol - therapeutic use</topic><topic>Humans</topic><topic>Hypnotics and Sedatives - administration & dosage</topic><topic>Hypnotics and Sedatives - adverse effects</topic><topic>Hypnotics and Sedatives - therapeutic use</topic><topic>Immobilization - methods</topic><topic>Male</topic><topic>Medical records</topic><topic>Mental Disorders - drug therapy</topic><topic>Mental health</topic><topic>Midazolam - administration & dosage</topic><topic>Midazolam - adverse effects</topic><topic>Midazolam - therapeutic use</topic><topic>Middle Aged</topic><topic>Oxygen saturation</topic><topic>Patients</topic><topic>Physical restraints</topic><topic>Prospective Studies</topic><topic>Psychiatric Department, Hospital</topic><topic>Psychiatry</topic><topic>Psychopharmacology</topic><topic>Psychotropic drugs</topic><topic>SAT assessment</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Violence</topic><topic>Vital signs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Calver, Leonie</creatorcontrib><creatorcontrib>Drinkwater, Vincent</creatorcontrib><creatorcontrib>Isbister, Geoffrey K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Calver, Leonie</au><au>Drinkwater, Vincent</au><au>Isbister, Geoffrey K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unit</atitle><jtitle>BMC psychiatry</jtitle><addtitle>BMC Psychiatry</addtitle><date>2013-09-18</date><risdate>2013</risdate><volume>13</volume><issue>1</issue><spage>225</spage><epage>225</epage><pages>225-225</pages><artnum>225</artnum><issn>1471-244X</issn><eissn>1471-244X</eissn><abstract>Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint and involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical practice is often guided by experience and there is little agreement on which drugs should be first-line treatment for rapid tranquilisation. This study aimed to investigate sedation for ABD in an acute mental healthcare unit, including the effectiveness and safety of high dose sedation.
A prospective study of parenteral sedation for ABD in mental health patients was conducted from July 2010 to June 2011. Drug administration (type, dose, additional doses), time to sedation, vital signs and adverse effects were recorded. High dose parenteral sedation was defined as greater than the equivalent of 10 mg midazolam, droperidol or haloperidol (alone or in combination), compared to patients receiving 10 mg or less (normal dose). Effective sedation was defined as a fall in the sedation assessment tool score by two or a score of zero or less. Outcomes included frequency of adverse drug effects, time to sedation/tranquilisation and use of additional sedation.
Parenteral sedation was given in 171 cases. A single drug was given in 96 (56%), including droperidol (74), midazolam (19) and haloperidol (3). Effective sedation occurred in 157 patients (92%), and the median time to sedation was 20 min (Range: 5 to 100 min). The median time to sedation for 93 patients receiving high dose sedation was 20 min (5-90 min) compared to 20 min (5-100 min; p = 0.92) for 78 patients receiving normal dose sedation. Adverse effects occurred in 16 patients (9%); hypotension (14), oxygen desaturation (1), hypotension and oxygen desaturation (1). There were more adverse effects in the high dose sedation group compared to the normal dose group [11/93 (12%) vs. 5/78 (6%); p = 0.3]. Additional sedation was given in 9 of 171 patients (5%), seven in the high dose and two in the normal dose groups.
Large initial doses of sedative drugs were used for ABD in just over half of cases and additional sedation was uncommon. High dose sedation did not result in more rapid or effective sedation but was associated with more adverse effects.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24044673</pmid><doi>10.1186/1471-244X-13-225</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; Springer Nature OA Free Journals; Springer Nature - Complete Springer Journals; PubMed Central |
| subjects | Adult Anesthesia Antipsychotics Blood pressure Clinical medicine Clinical practice guidelines Dosage and administration Droperidol - administration & dosage Droperidol - adverse effects Droperidol - therapeutic use Drug dosages Drug Therapy, Combination Emergency medical care Female Haloperidol Haloperidol - administration & dosage Haloperidol - adverse effects Haloperidol - therapeutic use Humans Hypnotics and Sedatives - administration & dosage Hypnotics and Sedatives - adverse effects Hypnotics and Sedatives - therapeutic use Immobilization - methods Male Medical records Mental Disorders - drug therapy Mental health Midazolam - administration & dosage Midazolam - adverse effects Midazolam - therapeutic use Middle Aged Oxygen saturation Patients Physical restraints Prospective Studies Psychiatric Department, Hospital Psychiatry Psychopharmacology Psychotropic drugs SAT assessment Time Factors Treatment Outcome Violence Vital signs |
| title | A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unit |
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