Sedation Drugs

    NextPrevious

    Sedation Drugs

     

    It’s 1 am and things are winding down.  The trickle of patients has slowed and it actually looks like you and your team are catching up.  Suddenly, you hear yelling, swearing and crashes coming from triage.  Other patients are looking around to see what is going on.  The sound of the triage nurse comes overhead, “hospital police to internal triage please, hospital police to internal triage.”  One day working in the emergency department is enough to know what that means.

     

    It’s not uncommon to require sedation for safety reasons in our line of work.  Acute agitation can be managed with a number of medications, but there are many choices.  Which is the best option (and don’t say droperidol, it’s off the market)?

     

    A prospective study published in June 2018 (see reference below) compared rapidity, safety and effectiveness of haloperidol 5 mg, haloperidol 10 mg, ziprasidone 20 mg, olanzapine 10 mg, and midazolam 5 mg.  Investigators rotated using each medication in 3 week blocks in the department for agitated patients, ultimately enrolling 737 study participants.  They found that midazolam 5 mg worked best, sedating 71% of patients within 15 minutes.  Olanzapine 10 mg sedated about 61%, ziprasidone 20 mg about 50%, and haloperidol 5 and 10 mg both about 40%.  Adverse outcomes were rare and no more prominent in any one group.

     

    Granted, 15 minutes is a long time when someone is acutely agitated.  The study looked at single agents only, not combos like the “5 and 2” or “B-52” if you really mean business, but if you do want to use a single agent, midazolam is likely going to be a better choice than haloperidol, especially since droperidol is no longer available.

     

    Want to read more about behavioral emergencies?  Click here:

    https://lifeinthefastlane.com/behavioural-emergencies/

    http://rebelem.com/chemical-sedation-of-the-agitated-patient/

     

    Reference:
    Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department.  Ann Emerg Med. 2018 Jun 6. pii: S0196-0644(18)30373-1. doi: 10.1016/j.annemergmed.2018.04.027.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    • Reach for the COWS

      Your patient in intake is miserable. Doubled over, complaining of pain everywhere, sweating, ill-appearing but not unstable. He tells you that the last time he used heroin was two nights ago, and he is askingRead more

    • Tis the season, summer edition

      As the late spring rains have begun to fade and the temperature rises mercilessly into the 80s and beyond, summer is finally upon us. And with summer comes a host of diseases for the emergencyRead more

    • Meet the newest member of your team

      We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist. In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know wellRead more

    • In the spirit of roasts and fire-breathing dragons

      You’re on a lovely amble through the backcountry when suddenly you see smoke rising nearby and catch a whiff of a familiar scent that throws you back to your med school OR days: burning flesh.Read more

    • E-point Septal Separation in the Patient with Congestive Heart Failure

      Perhaps never explained so clearly, Cisewki and Alerhand’s article on EPSS is a wonderful read. Bottom line to remember: EPSS > 7 mm was 87% sensitive and 75% specific at identifying reduced EF (<50%).  This isRead more

    • Lidocaine for cough?

      Whether it’s asthma, a U.R.I., or post nasal drip as the cause, cough is a common enough complaint encountered by emergency physicians everywhere. Of course you must always rule out the dangerous causes of coughRead more

    NextPrevious