Application of the equipment
Entonox
The equipment should be assembled and placed close to the casualty and the Entonox cylinder valve opened with the valve key. Offer the handpiece to the casualty and encourage them to apply the facemask over the face to create a good airtight seal.
Tell the casualty to breathe slowly and deeply for maximum benefit. If the casualty has trouble regulating their breathing, reassure them and encourage normal breathing patterns.
If the casualty displays anxiety at using the inhaler or mask, the mask should be removed and the casualty reassured and the process reiterated before trying again. Should the casualty still refuse or baulk at the process, remove it completely and attempt other treatment.
Ensure the casualty is told to expect 'clicking' or similar noises from the regulator, if this sound is heard it means the equipment is functioning correctly.
PenthroxTM Inhaler
- If available connect 3lpm or 8lpm of oxygen to the nipple in the base cap
- Open the 3ml bottle of Methoxyflurane or withdraw 3ml or 6ml of Methoxyflurane from the 125ml bottle using a glass syringe fitted with a stainless steel needle.
DO NOT USE PLASTIC SYRINGES
- To prime the wick, hold the PenthroxTM Inhaler on a slight angle to the vertical and slowly pour 3ml of Methoxyflurane onto the flat plate of the cap at the base of the nipple.
- If required a further 3ml may be added.
- maximum dose per patient is 6ml/day or 15ml/week
- Shake lightly to disperse the Methoxyflurane
- Explain the effect of inhaling Methoxyflurane vapour to the patient. Note the fruity smell. Aim for relief of discomfort rather than the total abolition of pain
- If desired, gently fasten the tapes of the PenthroxTM Inhaler around the patient's wrist
- The patient places the mouthpiece of the PenthroxTM Inhaler in the mouth. With the diluter hole uncovered, air or oxygen is drawn in through the Methoxyflurane impregnated wick. Exhale through the nose
- After 8-10 breaths the diluter hole can be covered by the patient's index finger to provide a higher concentration of vapour if required
- If the patient prefers simultaneous inhalation through both nose and mouth, fit the shoulder adjacent to the mouthpiece into a standard anaesthetic facemask. This is then handed to the patient for self-administration as described above
- Instruct the patient to use the PenthroxTM Inhaler intermittently, but sufficiently to maintain adequate analgesia. This avoids early exhaustion of the charge, ineffective analgesia or undesired deepening effect
- Prolonged bidirectional breathing through the PenthroxTM Inhaler may tend to coat the wick with moisture, causing a decline in delivered vapour concentration
After priming, the PenthroxTM Inhaler can be thrown or lowered to inaccessible patients, providing the patient is able to understand its correct use.
Disturbed behaviour
Disturbed behaviour may be due to mental illness or it may be due to a temporary emotional disturbance.
Generally, disturbed behaviour may be classified as follows:
- Psychosis is a mental illness where the person loses touch with reality. Some forms are well known, with schizophrenia, bipolar disorder and paranoia, being the most commonly associated forms.
- Neurosis is usually a chronic condition where the person remains in touch with reality. The person may have an uncontrollable compunction to act in a particular way, with phobias (fears), obsessions and compulsions the most common neuroses. Anorexia nervosa and excessive anxiety are examples of neurosis.
- Transient aberrant behaviour is a minor condition of temporary mental instability due to a particular emotional or physiological condition. Premenstrual tensions, post-natal depression, inappropriate reactions to emotional stress, are all common aberrant behaviour conditions which last only temporarily.
It is important to remember mental illness is just that; an illness. Similar to other illnesses like diabetes and heart disease, mental illness has a regime of treatment that is designed to ease the symptoms.
The mentally ill person, when exhibiting symptoms, cannot help doing or saying things which, to others, appears bizarre and sometimes hurtful. Mental illness is a frightening and debilitating condition and those who suffer it deserve our help and understanding, not our pity.
Sufferers may also mask their symptoms. It is also important to note that people with a psychosis or neurosis don't always exhibit symptoms (they are not 'constantly ill'). They are often active, creative and contributing members of society indistinguishable from other bystanders while medication, counselling and their own positive attitude help them cope.
An estimated 20% of the population has some form of 'mental illnesses.
Psychosis
Psychosis is where the psychotic individual is withdrawn from the world and during the depths of illness, will perceive things differently. If a schizophrenic tells you they hear voices, then those voices will feel real to them.
Sign and symptoms
- Mood swings
- Irrational behaviour and inattention
- Disjointed speech patterns
- May refer to religious figures or to intelligence services (CIA, ASIO, MI5)
- Inappropriate conversation and accusations
- Deep depression, crying
- Manic behaviour
- Known history and taking medication
- The person may inform you they suffer from mental illness
Care and treatment
What to do in case of psychosis:
- LISTEN to what is said - remain objective
- Look, but don't stare, at the person when talking
- Ask 'open ended' questions like, 'Why do you think that? '
- Avoid platitudes; e.g. 'You will be all right!'
- Always be polite, no matter what provocation is offered
- Keep your voice calm - never shout. A calm demeanour helps encourage calmness in the affected individual
- Don't make sudden moves the person may misconstrue as a threatening gesture
- Never laugh AT the person and don't tell them YOUR troubles
- If a potentially violent situation is present, don't get between the psychotic person and the door
- Never get into a physical confrontation as you may get hurt
- Ask the person if they want help; e.g. 'Is there anyone you would like to see or talk to?'
- Give them any assistance you can, but don't make promises you can't keep
- Don't delay in a potentially violent situation and cause risk to the person, to yourself or to others - GET HELP