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Pulse Oximetry Use during Physical and Mechanical Restraints

2007; Elsevier BV; Volume: 33; Issue: 3 Linguagem: Inglês

10.1016/j.jemermed.2007.02.064

2352-5029

Kim J. Masters,

Cardiac Arrest and Resuscitation

The current use of pulse, respiration, and blood pressure to monitor the cardiorespiratory status of patients during physical and mechanical restraints is antiquated and inadequate. Counting pulse and breathing rates is a technology that would have been available to Pharaoh Tutankhamen, and blood pressure cuffs have been around for 100 years. All of these measures are difficult to obtain, as restrained patients are often agitated. All of these vital signs are elevated by anxiety and anger. As a result, they become inaccurate measures of the impact of restraints on the cardiorespiratory system. This can lead medical personnel to continue restraints and assume that vital sign elevations are due to patients being upset rather than possibly being a restricting effect of the containment. Yet, morbidity and death from restraints has caused a public outcry. In 1999, the Hartford Courant reported that 144 deaths had occurred from restraints over a 10-year period ( 1 Weiss E. A nationwide pattern of death. Hartford Courant. 1998; (October 11.) Google Scholar ). A separate examination by the Joint Commission on the Accreditation of Health Care Organizations of 2400 sentinel events—serious or lethal situations in its accredited facilities from 1994–2004, found 115 of these were related to restraints. In them, suffocation was a common contributing factor to morbidity and mortality (personal communication, R. Croteau). Furthermore, a study of 46 physical-restraint-related deaths found that 29 (64%) of them were due to asphyxiation ( 2 Nunno M. Holden M. Tollar A. Learning from tragedy: a survey of child and adolescent restraint fatalities. Child Abuse Negl. 2006; 12: 1333-1342 Crossref Scopus (73) Google Scholar ). As a result of these reports, as well as two restraint-related deaths in nearby facilities, we looked for a more modern way of assessing cardiorespiratory functioning, hoping that it might help prevent fatalities during these procedures. This led us to examine cardiorespiratory assessment tools.