Moderator EMEDPA Posted September 7, 2014 Moderator Share Posted September 7, 2014 How do you folks treat the out of control patient in the e.d. who is so agitated you can't check VS, take a hx, etc? I'm talking either substance induced or pure psych or a mix of the two? had a guy methed out of his mind last night and interested if the rest of you do what I do. Link to comment Share on other sites More sharing options...
medic25 Posted September 7, 2014 Share Posted September 7, 2014 Our shop tends to use 5+2 (haloperidol and lorazepam) without the benadryl. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 7, 2014 Author Moderator Share Posted September 7, 2014 so just the "52". A flightless bird as it were (vs the typical "B52"). That was actually what I did for this guy. worked like a charm. At other places I work they prefer zyprexa/Ativan so I have done that as well. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted September 7, 2014 Share Posted September 7, 2014 If I have no idea what's causing it then the B52. But that's rarely been the case. If I think its pure psyche I will do heavier on the haldol (may start with 10) and benadryl. Alcohol a$$holes get more haldol (routinely start with 10). I try to avoid benzos with them. Methheads get more benzos than haldol. Only really give haldol if they are hallucinating. Then, of course, there is the polypharm schizophrenic.....kitchen sink?? Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 7, 2014 Moderator Share Posted September 7, 2014 B52 say good night...... Link to comment Share on other sites More sharing options...
PACdan Posted September 7, 2014 Share Posted September 7, 2014 Anyone use the mythical Geodon I've heard tossed around? Some of the nurses/docs I worked with made it sound like magic. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 7, 2014 Author Moderator Share Posted September 7, 2014 Anyone use the mythical Geodon I've heard tossed around? Some of the nurses/docs I worked with made it sound like magic. I talked a schizophrenic guy in the e.d who was pretty out of it into taking it orally once. the next step would have been holding him down for the b52 and I think he knew it. worked fine. it was his regular rx and he had stopped taking it several days earlier and become acutely psychotic. Link to comment Share on other sites More sharing options...
treejay Posted September 8, 2014 Share Posted September 8, 2014 to clarify B52 is benadryl (dose?) haldol 5mg IM vs IV? ativan 2mg IM vs IV? Why the benadryl? just because it's sedative? Link to comment Share on other sites More sharing options...
gbrothers98 Posted September 8, 2014 Share Posted September 8, 2014 Tried Geodon once orally, lot of pushback from pharmacy to stock it due to cost. One of our guys was sold on it and pushed the issue and we got it. Used it with manic 20 yr old, first psychotic break. Really just a spit in the wind. Haldol5/Ativan2 made him into a puppy dog. I use Haldol for agitated intoxicated patients. One thing that I will use periodically on the agitated but still not out of control is some intranasal versed, short acting, takes the edge off and serves as a chemical distractor rather than a show of force or true chemical restraint. G Brothers PA-C Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 8, 2014 Author Moderator Share Posted September 8, 2014 to clarify B52 is benadryl (dose?) haldol 5mg IM vs IV? ativan 2mg IM vs IV? Why the benadryl? just because it's sedative? usually benadryl 25/haldol 5 and ativan 2. all IM. 2 shots as ativan doesn't mix well. hard to get an IV in a guy who won't stop moving. I like Geo. Brothers idea about the intranasal versed. I may try that with someone who I don't think will bite me. IV is great when you have one. A lot of these folks you can't even get on a stretcher. you just get them in a room with security outside and try to talk them into IM meds. if that fails you hold them down with someone on each arm and leg and someone with a towel for the mouth to prevent biting and you put 2 quick im shots where ever you can get them then back away. kind of like the way you approach a mad elephant. you don't want them to hurt themselves, you or your staff. I know some older guys who just paralyze and intubate folks like this. that is a little too draconian for me. for many of these folks(the psych ones anyway) they didn't do this on purpose and can't help themselves. I have a little less compassion for the meth head who does this repeatedly. Link to comment Share on other sites More sharing options...
RetNavyPAC Posted September 9, 2014 Share Posted September 9, 2014 There's a great Emergency Medicine Clinics of North America article on this from 2010. If someone could help me figure out how to attach it to share I'd appreciate it. I can't seem to figure it out on the site (it ain't intuitive) Link to comment Share on other sites More sharing options...
Derbingle Posted September 10, 2014 Share Posted September 10, 2014 Drug induced get B52s to start, followed by haldol if not working. Zyprexa being used currently bc pharm is out of haldol for weeks now. Zyprexa working well, some docs doing hour post ekg d/t possible long QT. Meth headbthe other night got ativan 4, haldol 10 and still activated fighting, zyprexa 10 worked. Ekgs x2 post. Link to comment Share on other sites More sharing options...
primadonna22274 Posted September 11, 2014 Share Posted September 11, 2014 The Benadryl is for the extrapyramidal symptoms likely with 5-10 of Haldol. Just don't do what some idiot attending did in my ED last week...this girl comes in severely dystonic (the worst I've ever seen, and I've seen quite a few...we're talking oculogyric crisis) and combative and nutty out of her mind. B52 (10 of Haldol for good measure) to calm her down enough to scan her head. So much motion artifact you could barely read it but she had a basal ganglia stroke on the contralateral side. I got her for admission an hour later--back in oculogyric crisis, wacky as all get-out. Practically opisthotonic. I give her 50 more Benadryl IM. Get the story from boyfriend. She ran out of Xanax a couple wk earlier and had been popping Haldol like she was used to popping her Xanax. Got weirder and worse and fell frequently, multiple injuries. She got 50 of Benadryl an hour for several more hours (I said NO MORE DOPAMINE ANTAGONISTS!!!!) and she still required propofol sedation and artificial ventilation just to keep her calm. And round-the-clock Benadryl. And her brain is never gonna be the same. Respect the drugs you use folks. I was embarrassed that an EM-trained doc didn't recognize the acute severe dystonia that was the essence of her problem. Link to comment Share on other sites More sharing options...
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