Sedating an agitated patient is sometimes the only safe option, and it always costs you something diagnostically. Once the patient is sedated, the examination you did not do is gone until they wake, and the causes that most need finding — hypoglycaemia, hypoxia, sepsis, head injury, anticholinergic or sympathomimetic toxicity, withdrawal — are the ones a psychiatric label hides.
So make the thirty seconds before the drug count. Capillary glucose, oxygen saturation, temperature, pupils, and a look for head injury and track marks can all be obtained during restraint, and none of them can be obtained afterwards from a sleeping patient. Note the time of any drug the patient may have taken, from whoever brought them in, before that person leaves.
Write what you found in those thirty seconds contemporaneously. A note written after the patient settles reliably records the sedation and not the state that justified it — which is the part that matters both clinically and if the episode is later reviewed.
- Capillary glucose, saturations and temperature before sedation, every time — all obtainable during restraint
- Look at pupils and check for head injury and injection sites before the patient is asleep
- Take a collateral history from whoever brought the patient in before they leave the department
- Document the pre-sedation state contemporaneously, not retrospectively once the patient is settled
- Record the indication, drug, dose, route and time, and set the monitoring level at the same moment
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