Abstract:
Hypodermic syringes with multiple needles are used to practice a method of calming psychiatric patients. In accordance with one embodiment of the invention generally used to calm violent adult patients, the syringe has a first barrel containing an antipsychotic, a second barrel containing a sedating antihistamine and a third barrel containing an antianxiety sedative. Each barrel also has a separate projecting needle and contains a piston. A common operator, preferably in the form of a plunger simultaneously pushes all of the pistons so that the patient receives three injections simultaneously. For children, a second embodiment of the syringe includes two barrels instead of three, each barrel containing a separate medication. In each embodiment the syringe is packaged in a manually openable plastic envelope with a safety cap over the needles.

Description:
FIELD OF THE INVENTION  
       [0001]     The present invention relates to hypodermic syringe with multiple needles and to methods of calming psychiatric patients using such. More particularly, the invention relates to administering medication to psychiatric patients during difficult situations.  
       BACKGROUND OF THE INVENTION  
       [0002]     In psychiatric in-patient units and emergency rooms, patients can become violent. On these occasions they can harm to themselves or others. In addition, they frequently resist the efforts of staff to console, and de-escalate them. When verbal reasoning fails, and violence towards others or self-destructive behavior persists, it is a psychiatric emergency. In this situation, the staff often employs use of medications which quickly sedate the violent or physically threatening patient. Many steps must occur simultaneously to sedate these patients, and this poses some risk to the staff and the patient while administering these medications.  
         [0003]     The medications used during such an emergency, are antipsychotics (such as haloperidol), benzodiazepines (such as Lorazepam), and a sedating antihistamine (such as Diphenhydramine). Alternatively, Benztropine can be used in place of Diphenhydramine. These medications are used in combination and are administered intramuscularly (needle is inserted directly into the skin, often in the deltoid or buttocks) because the patient frequently will not agree to take these medications orally. In addition, the onset of the effects of the medications is faster when administered by intramuscularly.  
         [0004]     The staff must do a number of things during an episode in which a patient is violent. First, several staff must hold the patient&#39;s limbs (arms and legs), to prevent the patient from attacking them or resisting administration of the medications. Second, the staff will likely place the patient in locked leather restraints (leather straps that secure the patient&#39;s arms and legs to the corners of the bed or stretcher). Third, they will then administer the medications. There is some danger in bringing a needle near a patient that is resisting the staffs efforts to restrain them. In particular, the patient can pull or push the needles into a staff member or himself.  
         [0005]     In addition to the danger of manipulating a needle around a violent patient, there is the issue of urgency. Often times it is a nurse, nurse&#39;s aid, or mental health worker that first witnesses the violent act or aggressive act, and alerts the psychiatrist on call to make a determination as to whether there needs to be administration of medications intramuscularly. Often times the psychiatrist on call is not immediately present on the scene, and it may take time for the psychiatrist on call to establish contact with the unit. During this period the staff on the scene must physically restrain the patient, and a nurse may preemptively draw up medications to be ready should the psychiatrist on call order them. In these circumstances only the registered nurses are authorized to draw up and administer these medications. However, the nurse is often physically involved in restraining the patient, or helping the nurse&#39;s aids or mental health workers in the process, while assuming a leadership roll until the psychiatrist on call arrives. In these situations the nurse has to leave the scene, go to the medicine room, and take time to draw up the medications in needle(s), and then return to the bed where the patient is being restrained. This deprives the staff of one person for some time.  
         [0006]     Currently a nurse must spend considerable time locating and opening packaging and drawing several medications into one or multiple syringes. The nurse then has to push the plunger on each syringe, and pay attention to the needles already injected. Often this is done while the patient is struggling. Thus current practice has substantial drawbacks.  
       SUMMARY OF THE INVENTION  
       [0007]     In view of the aforementioned considerations, a syringe useful in the treatment of a psychiatric patient comprises multiple barrels, each containing a different medication, each having a piston therein, and each having a hypodermic needle projecting therefrom. The barrels are mounted in a single housing having first and second ends, the housing enclosing the chambers with the needles projecting from the first end of the housing. An operator associated with the housing is coupled to the pistons for simultaneously pushing the pistons into the chambers toward the needles to inject the medications substantially simultaneously into the patient.  
         [0008]     In a further aspect, some medications utilized, are an antipsychotic, a sedating antihistamine and an antianxiety sedative.  
         [0009]     In a further aspect of the syringe, a readily removable protective cap is positioned over the needles and the syringe is in combination with a manually openable plastic package.  
         [0010]     In a further aspect of the syringe, the antipsychotic is Haloperidol, Chlorpromazine, Ziprasidone, Risperidone, Quetiapine or Aripiprazole and the sedating medications are Lorazepam and Diphenhydramine. In addition, Benztropine and Diphenhydramine are used for prophylaxis of potential side effects of the antipsychotic. Thus, Benztropine is sometimes used instead of Diphenhydramine.  
         [0011]     In still a further aspect of the syringe, the needles are of different internal diameters and in still another aspect of the invention, the operator associated with the housing is a plunger projecting from a second end of the housing and coupled to the pistons within the chambers to push the pistons upon being manually pressed into the housing.  
         [0012]     The invention is also directed to a method for treating a violent and struggling patient comprising injecting the patient simultaneously with an antipsychotic, and sedating medications from one syringe through at least three needles at spaced sites on the patient.  
         [0013]     In still a further aspect of the invention, the medications injected are Haloperidol, Chlorpromazine, Olanzapine, Lorazepam, Chlordiazepoxide, Ziprasidone, Risperidone, Quetiapine or, Aripiprazole, Diphenhydramine or Benztropine.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0014]     Various other features and attendant advantages of the present invention will be more fully appreciated as the same becomes better understood when considered in conjunction with the accompanying drawings, in which like reference characters designate the same or similar parts throughout the several views, and wherein:  
         [0015]      FIG. 1  is a side view of a first embodiment of the syringe configured in accordance with the principles of the present invention;  
         [0016]      FIG. 2  is a side view of a second embodiment of a syringe configured in accordance with the principles of the present invention, and  
         [0017]      FIG. 3  is a side view of the syringe of  FIG. 1  or  2  packaged prior to use. 
     
    
     DETAILED DESCRIPTION  
       [0018]     Referring now to  FIG. 1  there is shown a first embodiment  10  of a syringe  12  configured in accordance with the principles of the present invention wherein the syringe  12  comprises a housing  14  containing therein three cylindrical syringe barrels  16 ,  18  and  20 . Each cylindrical syringe barrel  16 ,  18  and  20  contains a different medication  22 ,  24  and  26  and separate pistons  28 ,  30  and  32 , respectively for ejecting the medications from the barrels. Separate needles  34 ,  36  and  38  project from the barrels  16 ,  18  and  20 , respectively out of a first end  30  of the housing  14 . The barrels, pistons therein and needles projecting therefrom, are in a preferred embodiment of the syringe  10  separate hypodermic injectors which are mounted together in the single housing  14  in order to operate simultaneously. Each of the barrels  16 ,  18  and  22  has a front end that abuts a stop  30  within the housing so that as the pistons  28 ,  30  and  32  are pushed, the three medications  22 ,  24  and  26  are ejected through the needles  34 ,  36  and  38 .  
         [0019]     The pistons  28 ,  30  and  32  have piston rods  42 ,  46  and  48  projecting therefrom which are connected via a common coupling  50  to a plunger  52 . The coupling  50  utilizes a surface which bears simultaneously against outer end portions of the piston rods  42 ,  44  and  46 .  
         [0020]     The plunger  50  has an end portion  54 , which may be either a pad or a ring, while the housing of the syringe  14  has a pair of finger flanges  60  so that the syringe  12  can be operated with one hand with the physician or nurses forefinger and middle finger being in front of flanges  60  and the thumb pressing against the pad  54 , which may be provided by a portion of a thumb ring  62 . Preferably, the plunger  52  is held projected out of the housing  14  by a safety detent or other safety device  70  which can be quickly shifted out of engagement with the plunger  50  in order to allow the plunger to be pressed into the housing.  
         [0021]     Referring now to  FIG. 2  there is shown a second embodiment of the invention which includes two barrels  80  and  82  with associated needles  84  and  86  to comprise a second embodiment  10 ′ of the syringe  12 . The second embodiment  10 ′ is useful in calming highly disturbed, violent children who may injure others or themselves.  
         [0022]     Referring now to  FIG. 3  there is illustrated a preferred package for the syringes  12  of either  FIG. 1  or  FIG. 2  wherein the syringes are packaged in a plastic envelope  100 . The plastic envelope is readily openable by tearing a creased end  102  having ridges and grooves. The tear propagates along a line  104  to expose the syringe  12 . The syringe  12  is packaged with a protective cap  106  which is removed by the physician or nurse prior to use. Since the plunger  52  is extended out of the housing  14 , the syringe  12  is usable immediately upon removal from the package and after removal of the cap  106 . Preferably, the cap  106  snap fits with the housing  14  of the syringe so as to be readily manually removable therefrom.  
         [0023]     The psychiatrist and nurse are thus provided a pre-packaged unit  108  with commonly used doses of medications  22 ,  24  and  26  frequently administered to violent or agitated psychiatric patients, which pre-packaged unit minimizes time a nurse may have to spend away from a violent situation involving a patient. By having the pre-packaged unit  108 , a mental health worker or nurse&#39;s aid obtains the pre-packaged syringes  10  and brings them to the scene, thus obviating the need for a nurse to leave his or her leadership role. In addition, if the nurse is the one that retrieves the pre-packaged needles, the nurse does not have to spend time drawing-up three different medications; nor does the nurse have to manipulate three separate ampoules; nor does the nurse have to draw different medications into at least one syringe, or perhaps more than one syringe, if the medications do not fit into a single syringe. Normally the doses used for psychiatric purposes are commonly employed so the pre-packaged arrangement  108  provides a convenience to the staff during emergencies by containing a combination of medications in a single tamper proof container.  
         [0024]     Preferably, the barrels  16 ,  18  and  20  are syringes already loaded with commonly used dosages of medications frequently used during psychiatric emergency situations. By having a single plastic protective cap  106  covering all three needles  34 ,  36  and  38 , the need for a nurse to manipulate three safety caps and inadvertently stick themselves is obviated.  
         [0025]     The syringe  12  decreases the time a nurse must spend locating and opening packaging and must spend drawing medications into one or multiple syringes. In emergency situations where it would be inconvenient for a trained nurse to leave the patient, a less trained staff member can obtain a pre-packaged syringe  12  and bring it to the nurse for administration. As stated above, the need for the nurse to handle several separate needles in close proximity to a violent patient who is often thrashing limbs in attempts to resist staff is eliminated. Moreover, additional dose errors by a nurse already in a stressful situation is minimized because the nurse does not have to draw up medications and perform the milligram to milliliter conversions required when drawing medication into syringes. In addition, if a nurse is waiting for a response from an psychiatrist on call, the nurse can be prepared immediately once given the order, as opposed to waiting for an order and then drawing up anyone of many combinations of many medications.  
         [0026]     Commonly, violent or aggressive patients are administered 5 (mg) of Haloperidol, 1-2 mg of Lorazepam, and 50 mg of Diphenhydramine. Alternatively, 1-2 mg of Benztropine is used instead of the Diphenhydramine. In the usual situation three medications are administered to the patient. Consequently, the first embodiment  10  of the syringe  12  is used where a few medications are employed, as is the case involving adults where three medications are frequently utilized.  
         [0027]     When violent or physically aggressive children need to be calmed, the second embodiment  10 ′ of the syringe having two barrels is used. As an antipsychotic, Chlorpromazine may be used, which comes in a solution that contains 25 mg of Chlorpromazine per ml. Children may receive doses of 12.5 to 50 mg. of Chlorpromazine. In addition, children may also receive Lorazepam in doses of 0.5 mg or 1 mg. Accordingly, the pediatric population requires a minimum of two different medications during episodes of violence.  
         [0028]     Already in place are the medications in solution form. Haloperidol is available in a solution that contains 5 mg per milliliter (ml); Lorazepam is available in solutions that contain 2 mg per ml; Diphenhydramine is available in a solution that contains 25 mg or 50 mg per ml, and Benztropine is available in a solution that contains 1 mg per ml. Based on these concentrations, for the typical adult patient; a minimum of 1 ml of Haloperidol, 1 ml of Diphenhydramine, and 0.5 ml of Lorazepam (at a minimum of 2.5 ml of solution) would be needed in a syringe  12 . Nurses can use a 3 cc syringe, which would hold all the medications for a minimum dosing: 5 mg of Haloperidol, 1 mg of Lorazepam, and 50 mg of Diphenhydramine. However, once the dose increases, multiple needles will likely be employed. Frequently for a greater amount of sedation 2 mg of Lorazepam is used for a large or extremely violent patient. There are larger syringes available such a s10 cc or 20 cc syringes, which could hold larger doses. However, when this is done a larger bore needle must be employed. The 3 cc needle can use a 21 or 22 gauge needle, which are small bore (small internal diameter) needles. The larger syringes can also utilize a 21 or 22 gauge needle, but the increased volume of fluid takes a longer amount of time to inject through a smaller bore 21 or 22 gauge needle. Taking a longer amount of time is not practical when struggling with a violent patient.  
         [0029]     The dosing arrangements would come with the following combinations of medications.  
                                               ChemStraint           Diphenhy-           Combination   Haloperidol   Lorazepam   dramine   Benztropine                   A   5 mg = 1 ml   1 mg = .5 ml   50 mg = 1 ml           B   5 mg = 1 ml   2 mg = 1 ml   50 mg = 1 ml       C   5 mg = 1 ml   1 mg = .5 ml   None   1 mg = 1 ml       D   5 mg = 1 ml   1 mg = .5 ml   none   2 mg = 2 ml       E   5 mg = 1 ml   2 mg = 1 ml   none   1 mg = 1 ml       F   5 mg = 1 ml   2 mg = 1 ml   none   2 mg = 2 ml                  
 
         [0030]     It should be noted that the above combinations are not exhaustive. There are newer antipsychotic medications that are milder than Haloperidol or Chlorpromazine. Some of these newer medications include Olanzapine, Ziprasidone, Risperidone, Quetiapine, and Aripiprazole. Intramuscular preparations of Risperidone, Ziprasidone and Olanzapine are available and could be employed in the present invention.  
         [0031]     The hypodermic syringe  12  preferably has a length of about 2.5 to 3 inches long depending on whether 1.5 or 1 inch needles  34 ,  36  and  38  are attached. The safety cap  106  snaps on and off to cover and uncover the three 21 or 22 gauge needles that are 1.0 or 1.5 inches in length. A 1.0 inch is preferable in children or thin adults.  
         [0032]     From the foregoing description, one skilled in the art can easily ascertain the essential characteristics of this invention, and without departing form the spirit and scope thereof, can make various changes and modifications of the invention to adapt it to various usages and conditions.