Physical restraint

Question 1

What’s delirium?

Answer 1

Acute confusional state is also known as delirium or acute organic brain syndrome

Question 2

Predisposing factors for delirium

Answer 2

• age > 65 years
• background of dementia
• significant injury e.g. hip fracture
• frailty or multimorbidity
• polypharmacy

Question 3

Predisposing events/causes of delirium

Answer 3

• infection: particularly urinary tract infections
• metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
• change of environment
• any significant cardiovascular, respiratory, neurological or endocrine condition
• severe pain
• alcohol withdrawal
• constipation

Question 4

Features/presentation of delirium

Answer 4

• memory disturbances (loss of short term > long term)
• may be very agitated or withdrawn
• disorientation
• mood change
• visual hallucinations
• disturbed sleep cycle
• poor attention

Question 5

Management of delirium

Answer 5

• treatment of the underlying cause
• modification of the environment

Sedative drugs:

• 1 mg IM Lorazepam
• haloperidol 0.5 mg
• olanzapine

Question 6

How to start restraining patient physically?

Answer 6

using arms and pushing the shoulders

Question 7

Environmental changes to calm the patient down

Answer 7

• curtains pulled round → to try to make the environment as unbusy as possible
• dim the lights
• use of quiet, soft voices