How a doctor or orderly would go about subduing a violent patient who needs medical attention?

Question

If the patient needs something injected is it called a tranquiliser or sedative? Where would it be injected? Neck, arm etc? Is a syringe used?

How long is the onset time of the stuff injected? What does it do to the patient?

Answer 1

Years ago before I became a nurse I was an orderly/attendant in a large hospital in Canton Ohio. If a patient became threatening or violent, especially on the locked psychiatric ward, there would be an announcement on the overhead,"Assistance Please, Unit Six South" which was the code for all the orderlies to report to that unit. The idea was that a show of force would often convince the patient to calm down. In case that did not work, the nurse would assign each of us a patient's limb to grab, should the show of force not work, and would give us a signal so that we would know when to pounce. The nurse would have already had an IM injection drawn up, and restraints would have been made ready to hold the patient until the medication kicked in. Once the patient had been taken down (and we tried to get them onto a bed if possible to avoid injury, the nurse injected the medication. I once got the snot knocked out of me by a patient who had been a professional boxer, when in the middle of a takedown one of the nurses thought my hand was the patient's, and pulled it away. I was jammed between the patient's chest, and someone laying overtop of me. My hand had been holding the patient's right arm, and as soon as his arm was freed, I saw this huge fist pull back and just pummeled me.  This is why it is better to be a nurse rather than an orderly!  The doctors never ever particiapated. They talked to the patient, but once the action started they stayed back.

Answer 2

In the ER where I go, the first thing is to physically restrain the patient with soft restraints. (around the ankles and the wrists). The ER also has specially designed rooms for psych patients with doors that lock on the outside and nothing in the room the patient can hurt themselves with.

If that doesn't calm the patient down, then the staff will typically give a shop that subdues the patient.

Where I live, the flight paramedics can give Succhinylcholine (depolarizing neuromuscular blocking drug). This can temporarily paralyze the patient, but we have to ventilate them.

Answer 3

I, too, am a ketamine fan. Dissociative anesthesia is rather odd to see. They tend to sit and stare as if daydreaming, but very deeply so. But it's surprising how many can be talked into taking oral haloperidol (or whatever else is handy) if the situation is appropriate. In any case, it isn't worth getting hurt over, and sometimes a cop with a taser is a better choice.

Answer 4

In the OR, we use ketamine.  The "ketamine dart" - not a real dart of course, but we can sneak up and give it IM right through clothing, usually in the upper arm, but thighs work nicely, too.

It works in just a few minutes, and depending on the dose, can lead to profound sedation or complete unconsciousness.  It causes a dissociative state.

I've used that on uncooperative children, mentally retarded adults and one memorably schizophrenic violent criminal (he was having a chicken bone removed from his ear - it was there to help him get better transmission from the aliens).

We could also use succinylcholine, which can be given IM and causes muscle paralysis, but then you have to be prepared to ventilate them.