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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by San Diegan on March 9, 2006, at 12:56:35
Why do they still insist on using Haldol as a chemical restraint? They have IM zyprexa now, and also injected benzo's work well.
What if I prefer physical restraints (if needed, of course) -- no side effects, I'd rather have that than be forced to take a drug.
How would one go about making the preference known, carry a card? And would ER or Psych hospital people respect that preference? hmm...
Posted by ed_uk on March 9, 2006, at 14:06:51
In reply to Chemical vs. Physical restraints, posted by San Diegan on March 9, 2006, at 12:56:35
Hello
High doses of haloperidol (Serenace, Haldol) can restrain patiens by causing parkinsonism. Lower doses may provide similar efficacy with less side effects eg. EPS.
It is my belief that conventional IM doses of haloperidol are too high. In the treatment of acute paranoid psychosis, mania or psychostimulant intoxication, an initial dose of 2mg IM is appropriate. Elderly or physically debilitated patients must receive reduced doses.
>They have IM zyprexa now, and also injected benzo's work well.
IM Zyprexa is new, expensive and its safety in patients with various medical conditions is less clear. Doctors sometimes fear that injected benzos may cause respiratory depression. This is a problem when resuscitation facilities are not immediately available.
>How would one go about making the preference known, carry a card? And would ER or Psych hospital people respect that preference? hmm...
You could have a card explaining that you react badly to APs.
Regards
Ed
Posted by ed_uk on March 9, 2006, at 14:23:26
In reply to Chemical vs. Physical restraints, posted by San Diegan on March 9, 2006, at 12:56:35
Midazolam (Versed, Hypnovel), a potent injectable benzo, is one of the most useful drugs for emergency tranquilisation. It acts particularly rapidly.
In most cases of acute mania or psychosis, physicians should avoid using injectable drugs unless it's absolutely necessary. Patients may be frightened, distressed and angered by forced injections.
Ed
Posted by ed_uk on March 9, 2006, at 14:54:00
In reply to Chemical vs. Physical restraints, posted by San Diegan on March 9, 2006, at 12:56:35
IM lorazepam (Ativan) is not well absorbed. It can work just as quickly when given orally. Lorazepam does work more rapidly when it's given IV but this may be difficult in intensely agitated patients!!! Midazolam (Versed, Hypnovel) is a very effective sedative when given IM or IV. It works quickly.
Olanzapine (Zyprexa) must be given IM. Haloperidol (Haldol, Serenace) can be given IM or IV. In psychiatry, it is usually given IM.
IM promethazine (Phenergan) is occasionally used as an adjunt to other drugs. It has a strong sedative effect.
Ed
Posted by Phillipa on March 9, 2006, at 23:14:00
In reply to Injections, posted by ed_uk on March 9, 2006, at 14:54:00
Hi Ed if a pt was of danger to self or others we gave 2mgIV ativan and 5mg IV haldol. It only sometimes worked in severly agitated pts and leather restraints were added and taken off as quickly as possible. Monitoring on a TV and checks every l0minutes. Love PJ O
Posted by San Diegan on March 9, 2006, at 23:19:14
In reply to Re: Injections » ed_uk, posted by Phillipa on March 9, 2006, at 23:14:00
Would you honor the patient's wishes if he wanted restraints only, no antipsychotics?
> Hi Ed if a pt was of danger to self or others we gave 2mgIV ativan and 5mg IV haldol. It only sometimes worked in severly agitated pts and leather restraints were added and taken off as quickly as possible.
Posted by ed_uk on March 10, 2006, at 15:26:36
In reply to Re: Injections » Phillipa, posted by San Diegan on March 9, 2006, at 23:19:14
Hi PJ
5mg IM haloperidol (Haldol) is a pretty 'standard' dose. I personally believe that it's too high for most people.........and it's certainly too high for most elderly people. 2mg could be used initially. As little as 0.25mg could be effective for a very elderly patient eg. in agitated delirium.
The problem with lorazepam (Ativan) is that is doesn't work quickly enough. Midazolam (Versed, Hypnovel) works much more quickly. Midazolam works well when given IM or IV. Lorazepam takes too long to 'kick in' when it's given IM.
I don't think leather restraints are used in England.
Love
Ed xx
Posted by ed_uk on March 10, 2006, at 15:27:53
In reply to Re: Injections » Phillipa, posted by San Diegan on March 9, 2006, at 23:19:14
>Would you honor the patient's wishes if he wanted restraints only, no antipsychotics?
I certainly hope so because I have had terrible reactions to antipsychotics - not that I'll need restraining any time soon ;-)
Ed
Posted by Phillipa on March 10, 2006, at 17:39:32
In reply to Re: Injections » Phillipa, posted by San Diegan on March 9, 2006, at 23:19:14
Oh course. But I've never seen that happen before. Most people are so delusional or aggressive they wouldn't voluntarily let someone restrain them. Fondly, Phillipa
Posted by Phillipa on March 10, 2006, at 17:41:43
In reply to Re: Injections » San Diegan, posted by ed_uk on March 10, 2006, at 15:27:53
Ed are you sure you don't want to be restrained? Love PJ O
Posted by yxibow on March 11, 2006, at 2:37:14
In reply to Re: Injections » ed_uk, posted by Phillipa on March 10, 2006, at 17:41:43
> Ed are you sure you don't want to be restrained? Love PJ O
I wont go there.... :) Oops, I did.
No, but seriously restraints are for the patients safety and the safety of the care providers. Its unfortunate that quick decisions must be made in ERs. I know I would react horribly to a high D2 AP -- Akathisia at the end of the Barnes Akathisia Scale, considering my short stay at an ER for vomiting/flu which ended in a quick decision to use Compazine (AAGH) and Benadryl that wore off before I left the ER. If only Ondansetron/Granisetron worked faster and didnt cost like $25 a dose. Actually I'd pay $25 not to have Compazine. Yes yes.
Posted by tizza on March 11, 2006, at 3:37:37
In reply to Re: Injections » Phillipa, posted by yxibow on March 11, 2006, at 2:37:14
Luckily I have never had to be restrained or injected but I have to admit that if I'm freaking out and can't get to a pdoc or GP I just head straight for Phenergan, it works great for me if I have run out of Valium and although I feel very groggy the next day I'm just glad that I can get something over the counter that stops me from totally freaking out and knocks me out. Paul
Posted by ed_uk on March 11, 2006, at 13:30:26
In reply to Re: Injections, posted by tizza on March 11, 2006, at 3:37:37
Hi P
Phenergan is one of the most sedating antihistamines available. It's OTC in the UK and in Australia, but not in the US - AFAIK.
Phenergan has been used by injection for emergency sedation of agitated pts. It seems to work quite well.
Kind regards
Ed
This is the end of the thread.
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