Haldol, Ativan, and Versed... oh my.
In the Emergency Department, some patients present very acutely and aggressively agitated. This is usually the result of illicit drug use or a schizophrenic who hasn't been taking medications (or both!). Fortunately, we have an arsenal of medications to help sedate the patient, as reviewed in a previous Tricks of the Trade post.
One study looked to answer the question of what single IM sedation agent is most effective, as measured by the shortest time to sedation and time to arousal.
Reference
Nobay F, Simon B, Levitt M, Dresden G. A Prospective, Double-blind, Randomized Trial of Midazolam versus Haloperidol versus Lorazepam in the Chemical Restraint of Violent and Severely Agitated Patients Academic Emergency Medicine. 2004, 11(7): 744-9. DOI: 10.1197/j.aem.2003.06.015
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What about IM droperidol--although there's the black box warning, there's been thousands of cases without major incident and fewer adverse effects than haldol. Main advantage is shorter onset and sedation.
ReplyDeleteIndeed; the QT prolongation black box is inane. Ondansetron has as much QT prolongation as droperidol.
ReplyDeleteDroperidol appears popular in Australia:
From 2005: http://www.ncbi.nlm.nih.gov/pubmed/16387219
From 2010: http://www.ncbi.nlm.nih.gov/pubmed/20868907
I was just talking to one of our EM residents about droperidol. I really miss it. It was a wonder drug in my book. Never had an adverse effect from it and I used it at least once every shift many years ago.
ReplyDeleteHow about Versed 5-10mg Intranasal? That or 5mg IM are our options in my EMS system. The advantage is no needles; the disadvantage is that the nose is close to the teeth :)
ReplyDeleteHow about defibritazer for those patients with teeth, followed by Versed 10mg IN?
http://lifeinthefastlane.com/2010/09/defibritazer/
Interesting about intranasal versed for adults in the prehospital setting. I don't think intranasal administration of meds is quite "in", at least where I practice in San Francisco. The debiritazer is indeed an "outside the box" idea!
ReplyDelete