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1 free Paramedic practice questions: Behavioral and Psychiatric Emergencies

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Question 1 of 1

During transport, a 28-year-old patient who is severely agitated is secured face down on the stretcher with the wrists and ankles restrained behind the back. The patient continues to struggle against the restraints. The vital signs are BP 152/94, P 138, R 36, and SpO₂ 93% on room air. What should the paramedic do?

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Correct answer · Reposition the patient supine on the stretcher

This patient is at risk of restraint asphyxia. Roll the patient supine. Face down with the wrists and ankles restrained behind the back, the patient cannot expand the chest wall or drop the diaphragm normally. The weight of the torso against the stretcher adds to the load on the chest. A struggling patient is making a large acid load. The body needs a high minute volume, which means moving a lot of air every minute, to make up for the acid. Limiting chest movement at that moment is how agitation turns into restraint asphyxia. The respiratory rate is 36 and the SpO₂ is 93% on room air in a 28-year-old. This patient is working against the restriction and losing. Prone restraint is not an accepted position to monitor a patient in any system. Move the patient supine or onto the side with the airway visible, and monitor continuously. Consider chemical sedation so the struggling stops adding to the acid load.

Why the others are wrong

Add a strap across the upper back and shoulders: A strap across the upper back and shoulders is standard for an agitated patient lying supine. On a supine patient, the strap keeps the patient from sitting up without limiting chest expansion. On a patient who is face down, the strap adds a second load right on top of a chest that already cannot expand. Pressure on a chest that cannot expand is the exact cause of restraint asphyxia.

Continue transport and monitor the patient closely: Close monitoring is right for a patient restrained supine with stable vital signs. In that patient, the risk is a change over time, and monitoring catches the change. Here monitoring only records a decline that monitoring cannot reverse. This young patient has a respiratory rate of 36 and a saturation of 93% on room air. The body is already failing to keep up. Watching does not change a mechanical restriction on the chest.

Loosen the wrist restraints and continue transport: Checking limb restraints is required care, because a restraint that is too tight cuts off circulation. Loosening the wrist restraints is right when the wrists are cool, cyanotic, or pulseless. Loosening the wrists while the patient stays face down leaves the chest just as compressed. Loosening the wrists also gives back the control that made the restraint necessary. The danger is the prone position and the weight on the torso, not the tension at the wrist.

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