Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 I have one but cannot forward until I get back from the coast. NAEMSP has a position paper I will forward as well. BEB Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 I have one but cannot forward until I get back from the coast. NAEMSP has a position paper I will forward as well. BEB Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. ======================================= Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. ======================================= Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. ======================================= Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Not forward doc post.. Please pretty please. thanks ======================================== Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Not forward doc post.. Please pretty please. thanks ======================================== Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Not forward doc post.. Please pretty please. thanks ======================================== Agitated Patients Hey everybody, If you could help me out, my medical director posed this question to me: " I have also been interested in an agitated patient protocol that might use chemical sedation (specifically haldol or geodon). Could you throw that out on your discussion group? " Dr. B, any help is appreciated, also anyone else, all help is appreciated. Ronnie Morton EMS There When You Need Us Ronnie L. Morton EMS Coordinator Marshall Fire Department p.o. Box 698 303 W. Burleson St Marshall, Texas 75671 rmorton@... tel: fax: mobile: pager: Powered by Plaxo Want a signature like this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 A quick review of the literature reveals this: Haldol is safe when used in appropriate doses, but it is relatively slow acting. However, many recommend combination therapy with benzodiazepines. Droperidol is used extensively in Europe and less extensively here. It has a much shorter onset than haloperidol, but there has recently been added a " black box " warning to it which states that it can cause Q-T prolongation leading to T de P and death in some patients. Some recommend banning it; others say, use it with caution. The articles I read recommend lorazepam + haloperidol. However, most EMS services do not carry lorazepam. That leaves diazepam and midazolam, the more commonly carried benzos. We carry haloperidol, diazepam and midazolam. I have successfully used haloperidol IM for a wild and crazy patient and found that the onset was quick enough to give us some relief from his fighting. In retrospect, I would have probably used midazolam IM together with haloperidol IM if I had it to do over again. I like midazolam because of its rapid onset, and it is a better IM drug than diazepam, I think. IV administration is, of course better, but in a fighting patient, sometimes the best thing to do is do an IM injection quick and easy. 3-5 mg midazolam + 10 mg haloperidol ought to do the trick in the average male crazy. Add more midazolam as necessary but watch respirations. Too much haloperidol at once can cause extrapyramidal reactions. If you ever see one, you'll remember it. The eyes can roll back so that you only see sclera, the tongue lolls out of the mouth farther than you think it possibly could, like a dog's, and torticollismay be present. Call the Exorcist. If the Exorcise is not available, 50 mg of diphenhydramine IM or IV will do nicely and cause the problem to resolve rapidly. I recommend that you use the IM route for both benzos and haloperidol in the fighting, wild and crazy patient. You can get the injection done in the butt, the delt, or the vastus lateralis and the patient hardly knows it. Right through clothing. Further precaution: Be prepared for mood swings and going from fighting to crying, back and forth. These patients are in crisis anyway you look at it. Do not take their assaultinve behavior personally; but do protect yourself and your partners. Know how to apply restraints, apply them, then document the s*** out of the whole incident. GG In a message dated 8/23/04 17:57:26 Central Daylight Time, silsbeeems@... writes: > Subj:Re: Agitated Patients > Date:8/23/04 17:57:26 Central Daylight Time > From:silsbeeems@... > Reply-to: > To: > Sent from the Internet > > > > Haladol is to slow is my only input and the chances you take trying to > administer it so the pt starts getting sedated about the time you arrive at a > hospital er if you have a long transport greater than > 20 minutes it just isn't > worth the needle being poked around there are other drugs that are better and > faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might > use > chemical sedation (specifically haldol or geodon). Could you throw that > out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Ronnie, This is a reasonably done systematic review of Pharmacological management of agitation in emergency settings published in 2003. I have found it useful several times in the last two months with agitated patients in an inpatient setting, but it was clearly looking at the emergency setting. There is no protocol, but it would be fairly easy to fashion a few. Nile for the full text: http://emj.bmjjournals.com/cgi/reprint/20/4/339 Pharmacological management of agitation in emergency settings ABSTRACT Objective: To review, firstly, published studies comparing classic antipsychotics, benzodiazepines, and/or combination of both; and secondly, available data on the use of atypical antipsychotic medications in controlling agitation and aggressive behaviour seen in psychiatric patients in emergency. Method: In the first review, studies comparing antipsychotics, benzodiazepines, and combination of both; and in the second review, efficacy trials of atypical antipsychotics that include an active and/or inactive comparator for the treatment of acute agitation were identified and reviewed. Data from clinical trials meeting the inclusion criteria were summarised by recording improvement rates, definition of improvement, and timing of defined improvement for individual studies. Results: In the first review, 11 trials were identified meeting the inclusion criteria, eight with a blind design. The total number of subjects was 701. These studies taken together suggest that combination treatment may be superior to the either agent alone with higher improvement rates and lower incidence of extrapyramidal side effects. In the review of atypical antipsychotic agents as acute antiagitation compounds, five studies were identified, three with a blind design. The total number of subjects was 711, of which 15% (104) was assigned to the placebo arm. This review found atypical antipsychotics to be as effective as the classic ones and more advantageous in many aspects. Conclusion: Atypical antipsychotics such as risperidone, ziprasidone, and olanzapine with or without benzodiazepines should be considered first in the treatment of acute agitation. If these agents are not available the combination of a classic antipsychotic and a benzodiazepine would be a reasonable alternative. An oral treatment should always be offered first for building up an alliance with the patient and suggesting an internal rather than external locus of control. ---------------------------------------------------------------------------- ---- =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= J. Nile , LP PharmD Candidate (May 2005) The University of Texas at Austin & The University of Texas Health Science Center at San E-mail: jnbarnes@... Phone: Pager: =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= Agitated Patients > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 Ronnie, This is a reasonably done systematic review of Pharmacological management of agitation in emergency settings published in 2003. I have found it useful several times in the last two months with agitated patients in an inpatient setting, but it was clearly looking at the emergency setting. There is no protocol, but it would be fairly easy to fashion a few. Nile for the full text: http://emj.bmjjournals.com/cgi/reprint/20/4/339 Pharmacological management of agitation in emergency settings ABSTRACT Objective: To review, firstly, published studies comparing classic antipsychotics, benzodiazepines, and/or combination of both; and secondly, available data on the use of atypical antipsychotic medications in controlling agitation and aggressive behaviour seen in psychiatric patients in emergency. Method: In the first review, studies comparing antipsychotics, benzodiazepines, and combination of both; and in the second review, efficacy trials of atypical antipsychotics that include an active and/or inactive comparator for the treatment of acute agitation were identified and reviewed. Data from clinical trials meeting the inclusion criteria were summarised by recording improvement rates, definition of improvement, and timing of defined improvement for individual studies. Results: In the first review, 11 trials were identified meeting the inclusion criteria, eight with a blind design. The total number of subjects was 701. These studies taken together suggest that combination treatment may be superior to the either agent alone with higher improvement rates and lower incidence of extrapyramidal side effects. In the review of atypical antipsychotic agents as acute antiagitation compounds, five studies were identified, three with a blind design. The total number of subjects was 711, of which 15% (104) was assigned to the placebo arm. This review found atypical antipsychotics to be as effective as the classic ones and more advantageous in many aspects. Conclusion: Atypical antipsychotics such as risperidone, ziprasidone, and olanzapine with or without benzodiazepines should be considered first in the treatment of acute agitation. If these agents are not available the combination of a classic antipsychotic and a benzodiazepine would be a reasonable alternative. An oral treatment should always be offered first for building up an alliance with the patient and suggesting an internal rather than external locus of control. ---------------------------------------------------------------------------- ---- =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= J. Nile , LP PharmD Candidate (May 2005) The University of Texas at Austin & The University of Texas Health Science Center at San E-mail: jnbarnes@... Phone: Pager: =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= Agitated Patients > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2004 Report Share Posted August 23, 2004 In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Dr. B., What about Hadol and Cogentin? Anyone out there use those two together for sedation? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Dr. B., What about Hadol and Cogentin? Anyone out there use those two together for sedation? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Dr. B., What about Hadol and Cogentin? Anyone out there use those two together for sedation? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Midazolam is a great IM drug becuase once injected, it becomes water soluble and crosses the blood braine barrier quite quickly. We also have the ability to give it intranasaly. In my service we use Midazolam 5mg and Haldol 5mg IM in a normal adult sized pt. If this doesn't work, then we have the availability to give another 5 + 5 IM. Hopefully this will calm the pt down enough so that we can get an IV, then we can give Ativan 2 - 4 mg IV if needed. The Midazolam 5mg and Haldol 5mg usually works, but you may have to fight the pt for a bit. I have used this combo a couple of times and was able to calm the violent pt enough to get an IV. D. Stone " Alfonso R. Ochoa " wrote: In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Midazolam is a great IM drug becuase once injected, it becomes water soluble and crosses the blood braine barrier quite quickly. We also have the ability to give it intranasaly. In my service we use Midazolam 5mg and Haldol 5mg IM in a normal adult sized pt. If this doesn't work, then we have the availability to give another 5 + 5 IM. Hopefully this will calm the pt down enough so that we can get an IV, then we can give Ativan 2 - 4 mg IV if needed. The Midazolam 5mg and Haldol 5mg usually works, but you may have to fight the pt for a bit. I have used this combo a couple of times and was able to calm the violent pt enough to get an IV. D. Stone " Alfonso R. Ochoa " wrote: In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Midazolam is a great IM drug becuase once injected, it becomes water soluble and crosses the blood braine barrier quite quickly. We also have the ability to give it intranasaly. In my service we use Midazolam 5mg and Haldol 5mg IM in a normal adult sized pt. If this doesn't work, then we have the availability to give another 5 + 5 IM. Hopefully this will calm the pt down enough so that we can get an IV, then we can give Ativan 2 - 4 mg IV if needed. The Midazolam 5mg and Haldol 5mg usually works, but you may have to fight the pt for a bit. I have used this combo a couple of times and was able to calm the violent pt enough to get an IV. D. Stone " Alfonso R. Ochoa " wrote: In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Gene- In my current practice, the agitated patient of " average " size will receive Ativan 2mg IM, Haldol 5mg IM and Benadryl 50mg IM. This has been an effective and well tolerated combination that combines the benefts of the more rapid onset of the Ativan, the long duration and deep sedation of the Haldol and taps the sedative and anti-pyramidal atributes of the Benadryl. Tho the IM route is not optimal for these drugs, the need for extreme physical restraint to provide safe conditions to start and maintain an IV can create an unwarranted risk of traumatic asphyxia to the patient or physical injury to both patient and practitioners. A couple of quick injections in the buttocks and the patient can be restrained in a less hazardous fashion or not at all as the conditions dictate. Even my most violent patients thus treated have been easily awakened, able to control their own airways, and quite manageable. The Paramedic, on the other hand, must continue to rely on caffeine, 27,000,000mg PO Q4, Ibuprophen 800mg PO Q12 and the occassional after hours Budweiser to attain maximum manageability. Regards- TD " These few precepts, keep in thy memory; See to thou character. Give thy thoughts no tongue, Nor any unproportioned thought his act. Be thou familiar, but by no means vulgar. Those friends thou hast, and their adoption tried, Grapple them to thy soul with hoops of steel; But do not dull thy palm with entertainment Of each new-hatch'd, unfledged comrade. Beware of entrance to a quarrel, but being in, Bear't that the opposed may beware of thee. Give every man thy ear, but few thy voice; Take each man's censure, but reserve thy judgment. Costly thy habit as thy purse can buy, But not express'd in fancy; rich, not gaudy; For the apparel oft proclaims the man, Neither a borrower nor a lender be; For loan oft loses both itself and friend, And borrowing dulls the edge of husbandry. This above all: to thine ownself be true, And it must follow, as the night the day, Thou canst not then be false to any man. " Hamlet - Polonious Advice Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 Gene- In my current practice, the agitated patient of " average " size will receive Ativan 2mg IM, Haldol 5mg IM and Benadryl 50mg IM. This has been an effective and well tolerated combination that combines the benefts of the more rapid onset of the Ativan, the long duration and deep sedation of the Haldol and taps the sedative and anti-pyramidal atributes of the Benadryl. Tho the IM route is not optimal for these drugs, the need for extreme physical restraint to provide safe conditions to start and maintain an IV can create an unwarranted risk of traumatic asphyxia to the patient or physical injury to both patient and practitioners. A couple of quick injections in the buttocks and the patient can be restrained in a less hazardous fashion or not at all as the conditions dictate. Even my most violent patients thus treated have been easily awakened, able to control their own airways, and quite manageable. The Paramedic, on the other hand, must continue to rely on caffeine, 27,000,000mg PO Q4, Ibuprophen 800mg PO Q12 and the occassional after hours Budweiser to attain maximum manageability. Regards- TD " These few precepts, keep in thy memory; See to thou character. Give thy thoughts no tongue, Nor any unproportioned thought his act. Be thou familiar, but by no means vulgar. Those friends thou hast, and their adoption tried, Grapple them to thy soul with hoops of steel; But do not dull thy palm with entertainment Of each new-hatch'd, unfledged comrade. Beware of entrance to a quarrel, but being in, Bear't that the opposed may beware of thee. Give every man thy ear, but few thy voice; Take each man's censure, but reserve thy judgment. Costly thy habit as thy purse can buy, But not express'd in fancy; rich, not gaudy; For the apparel oft proclaims the man, Neither a borrower nor a lender be; For loan oft loses both itself and friend, And borrowing dulls the edge of husbandry. This above all: to thine ownself be true, And it must follow, as the night the day, Thou canst not then be false to any man. " Hamlet - Polonious Advice Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 I hope it is water-soluble before injected. In order to cross the blood-brain barrier, drugs must be lipid soluble. Now back to school for you! Re: Re: Agitated Patients Midazolam is a great IM drug becuase once injected, it becomes water soluble and crosses the blood braine barrier quite quickly. We also have the ability to give it intranasaly. In my service we use Midazolam 5mg and Haldol 5mg IM in a normal adult sized pt. If this doesn't work, then we have the availability to give another 5 + 5 IM. Hopefully this will calm the pt down enough so that we can get an IV, then we can give Ativan 2 - 4 mg IV if needed. The Midazolam 5mg and Haldol 5mg usually works, but you may have to fight the pt for a bit. I have used this combo a couple of times and was able to calm the violent pt enough to get an IV. D. Stone " Alfonso R. Ochoa " wrote: In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2004 Report Share Posted August 24, 2004 I hope it is water-soluble before injected. In order to cross the blood-brain barrier, drugs must be lipid soluble. Now back to school for you! Re: Re: Agitated Patients Midazolam is a great IM drug becuase once injected, it becomes water soluble and crosses the blood braine barrier quite quickly. We also have the ability to give it intranasaly. In my service we use Midazolam 5mg and Haldol 5mg IM in a normal adult sized pt. If this doesn't work, then we have the availability to give another 5 + 5 IM. Hopefully this will calm the pt down enough so that we can get an IV, then we can give Ativan 2 - 4 mg IV if needed. The Midazolam 5mg and Haldol 5mg usually works, but you may have to fight the pt for a bit. I have used this combo a couple of times and was able to calm the violent pt enough to get an IV. D. Stone " Alfonso R. Ochoa " wrote: In our chemical restraint standard we are authorized to use 2.5 to 5.0 mg of midazolam. I haven't come across a situation where I had to use it yet, so I'm not sure how midazolam would compare to the other drugs used. Regards, Alfonso R. Ochoa > Haladol is to slow is my only input and the chances you take trying to administer it so the pt starts getting sedated about the time you arrive at a hospital er if you have a long transport greater than > 20 minutes it just isn't worth the needle being poked around there are other drugs that are better and faster. Some one else take it from here. > > ======================================= > Agitated Patients > > > Hey everybody, > > If you could help me out, my medical director posed this question to me: > > > > " I have also been interested in an agitated patient protocol that might use > chemical sedation (specifically haldol or geodon). Could you throw that out > on your discussion group? " > > > > Dr. B, any help is appreciated, also anyone else, all help is appreciated. > > > > Ronnie Morton > > > > > > EMS There When You Need Us > > Ronnie L. Morton > EMS Coordinator Marshall Fire Department > p.o. Box 698 > 303 W. Burleson St > Marshall, Texas 75671 > rmorton@m... tel: > fax: > mobile: > pager: > > > > > > > > Powered by Plaxo Want a signature like this? > > > > > > Quote Link to comment Share on other sites More sharing options...
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