Podcasts about droperidol

AFR EMS Case Studies Droperidol Use On The Fire Ground 1 by Albuquerque Fire Rescue

AFR EMS Case Studies Droperidol Use On The Fire Ground by Albuquerque Fire Rescue

Contributor: Aaron Lessen MD Educational Pearls: A recent randomized controlled trial compared ondansetron 8 mg IV with droperidol 2.5 mg IV for the treatment of nausea & vomiting in the emergency department.  Overall, droperidol and ondansetron had similar primary outcomes in acute nausea control  Symptom improvement in 93% of patients receiving droperidol vs. 87% receiving ondansetron (P = 0.362) Secondary measures were, however, statistically significantly different between groups Patients needed fewer rescue/additional antiemetics in the droperidol group (16%) compared with the ondansetron group (37%); p = 0.016 Similarly, more patients in the droperidol group reported they achieved the desired effect of the medication (85% vs. 63%; p = 0.006) Patients receiving droperidol did experience increased drowsiness 40% in the droperidol group vs. 11% in the ondansetron group The trial did not assess the length of stay in the ED after administering medications, which is a potential avenue for future research. References 1. Philpott L, Clemensen E, Lau GT. Droperidol versus ondansetron for nausea treatment within the emergency department. EMA - Emerg Med Australas. 2023;(December 2022):605-611. doi:10.1111/1742-6723.14174 Summarized & Edited by Jorge Chalit, OMSII  

Podcast summary of articles from the March 2023 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include video laryngoscopy, airway stylets, PE imaging in pregnant patients, mucormycosis, naloxone, and droperidol.  Guest speaker is Dr. Mitch Skinner.

In this second episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with comorbid medical conditions. Lastly, they consider the different causes for repeat visits from mentally ill patients.    Key Points:   Pharmacologic treatments for substance-induced psychosis are similar to those for other types of psychosis; these include medications like Zyprexa, Haldol, and, as a third-line treatment, IM Thorazine.  Droperidol is used more commonly in the emergency setting, compared with the psychiatric setting.  Given the risk for respiratory depression from Zyprexa combined with benzodiazepines, psychiatrists may choose to use Thorazine or Haldol/Ativan/Benadryl instead.  It is important to reassess patients after substances wear off to determine whether they meet criteria for admission to inpatient psychiatry, though psychiatric assessments are limited by geographic constraints. The admitting psychiatry team will reassess the patient to differentiate substance-induced psychosis vs other psychoses; often this includes obtaining collateral. Helpful notes from the ED include: medications administered or restraints placed (can help extrapolate a patient's level of agitation), vital signs, prior records.  Some people will be more open about suicidality while intoxicated and less open about it while sober so it is important to obtain additional information for corroboration.  On average, patients stay in the detox unit for 3-4 days, though some may stay longer for protracted substance-induced psychosis if they have a long-standing history of daily substance use.  It is important to discharge patients with quick follow-up and potential placement into the various mental health programs including partial hospitalization, residential, or outpatient programs. Emergency rooms can improve by taking psychiatric patients seriously, especially when they are transferred to the hospital from a psychiatric facility for medical management.  Repeat visits stem partially from the ambivalence that accompanies substance use disorders, including patients' difficulty in giving up the substance due the purpose it may serve in their lives.  Many substance use disorder programs are siloed from the medical system, which pose a challenge to interdisciplinary communication. 

The JournalFeed podcast for the week of July 4 to 8th, 2022. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Is Paxlovid Working Spoon Feed: In the omicron era, nirmatrelvir/ritonavir (Paxlovid) is highly effective in reducing the risk of severe COVID-19 and mortality. Peds Droperidol Spoon Feed: This systematic review suggests that droperidol is both safe and effective for treating agitation in the pediatric population.

Droperidolün    Tarihçesi    Etki Mekanizması    Metabolizma ve Farmakokinetiği    Santral Sinir Sistemi Üzerine Etkileri   Solunum Sistemi Üzerine Etkileri   Kardiyovasküler Sistem Üzerine Etkileri  Kullanım Şekilleri

On Episode 126, the podcast crew was able to catch up with the one and only Dr. Jeff Jarvis at Texas EMS in Austin. Dr. Jarvis is a longtime fan of droperidol for multiple uses in the prehospital setting ranging from acute headache treatment to sedation and as an anti-emetic. Let this be a warning, we're all droperidol zealots in this discussion. Listen and learn practical ways to implement droperidol into your EMS practice.

We've recently rolled out a new medication protocol here at MCHD. Join the medical directors to discuss the why, when, and how behind MCHD's droperidol protocol. Like many pharmacologic treatments in emergency medicine, old becomes new again! REFERENCES 1. Page CB, Parker LE, et al. A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance. Prehosp Emerg Care. 2018 Nov-Dec;22(6):713-721.

Rory and Ryan discuss Droperidol, the HEART Score, machine learning's ability to predict ICU admission, and much much more.

It's the JournalFeed Podcast for the week of September 20-24, 2021. We cover EM workforce projections, ETCO2 for OHCA in PEA, NSAIDs and non-union risk, IM droperidol vs olanzapine for agitation, and IM ketamine vs midazolam/haloperidol for agitation.

Contributor: Nick Tsipis, MD Educational Pearls: Prospective trial studied 5 mg IM droperidol to 10 mg IM olanzapine (Zyprexa) in the reducing levels of agitation Time to adequate sedation was about 16 minutes for both agents Droperidol was slightly less sedating than olanzapine and length of stay for olanzapine was longer Olanzapine had a higher rate of requiring another agent for adequate sedation Droperidol had a higher rate of adverse events (mainly extrapyramidal symptoms) than olanzapine Remember to put the safety of the staff and patient at the forefront of sedation practices and be cognizant of the psychological effect of giving involuntary medications to patients References Cole JB, Stang JL, DeVries PA, Martel ML, Miner JR, Driver BE. A Prospective Study of Intramuscular Droperidol or Olanzapine for Acute Agitation in the Emergency Department: A Natural Experiment Owing to Drug Shortages. Ann Emerg Med. 2021;78(2):274-286. doi:10.1016/j.annemergmed.2021.01.005 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Show note at pharmacyjoe.com/episode614 . In this episode, I'll discuss which works better for agitation in the ED - droperidol, ziprasidone, or lorazepam? The post 614: Which works better for agitation in the ED - Droperidol, Ziprasidone, or Lorazepam? appeared first on Pharmacy Joe.

Show note at pharmacyjoe.com/episode614 . In this episode, I ll discuss which works better for agitation in the ED droperidol, ziprasidone, or lorazepam? The post 614: Which works better for agitation in the ED Droperidol, Ziprasidone, or Lorazepam? appeared first on Pharmacy Joe.

Date: April 19th, 2021 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). She is Chair of the Royal College of Emergency Medicine Women in Emergency Medicine group and involved with the RCEM Public Health and Informatics groups. Kirsty is […]

Contributor:  Aaron Lessen, MD Educational Pearls: Droperidol for sedation in agitated patients in the emergency department was studied compared to ziprasidone (Geodon) and lorazepam (Ativan) Double-blinded RCT showed droperidol was 65% effective to get patients to a good level of sedation in 15 minutes compared to ativan and geodon which were 25-35% effective Droperidol had less respiratory depression and prolongation of the QT compared to Ativan and Geodon References Martel ML, Driver BE, Miner JR, Biros MH, Cole JB. Randomized Double-blind Trial of Intramuscular Droperidol, Ziprasidone, and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Acad Emerg Med. 2021 Apr;28(4):421-434. doi: 10.1111/acem.14124. Epub 2020 Oct 5. PMID: 32888340. Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

This is part 3 of 3 recapping our most recent journal club where we looked at the evidence for the safety and efficacy of droperidol for treating acute agitation in the ED. In this final episode, Dr. Christa Pulvino will share her summary of the DORM trial done by Isbister et al which looked at IM droperidol vs midazolam for violence and acute behavioral disturbance in the ED.

This is our second in a 3 part series looking at the evidence for the safety and efficacy of droperidol for acute agitation in the ED. In this episode, Dr. Shawn Hassani leads us in a discussion of an article by Taylor et al which was a randomized trial of droperidol vs droperidol + midazolam vs olanzapine.

This is part 1 of our 3 part series recapping our most recent journal club. In this podcast, Dr Jeff Hill leads a discussion of a paper by Calver et al which was a multicenter prospective trial looking at the safety and efficacy of droperidol for acutely agitated patients in the ED

December 4, 2001. A bad day, indeed. That's the day the FDA issued a black box warning for droperidol, citing evidence of QT prolongation, Torsades de Pointes, and death. This was a surprise warning because droperidol had been extensively used by emergency medicine and anesthesiology for decades without apparent problems. Since this bad day, we've essentially been without droperidol. Fortunately, it's back! Before we start using it again, we should take a look at what got this drug on the FDA's radar. Dr. Jarvis reviews the literature about the “evidence” behind the warning and describes how his systems will be bringing droperidol back into practice.

This week, we discuss which agents to use to control agitation in a few different clinical scenarios encountered in the ER.Please click HERE to leave a review of the podcast!References:All references for Episode 45 are found on my Read by QxMD collection

View the full show notes on Google Docs here: http://bit.ly/3cpvlJc 2020 BLS/ACLS Guideline Changes Merchant RM, Topjian AA, Panchal AR, et al. Part 1: Executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Published October 21, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000918 Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. American Heart Association. Published 2020. Accessed January 20, 2021. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts2020eccguidelinesenglish.pdf Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get with The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. Published April 9, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.047463 Topjian A, Aziz K, Kamath-Rayne BD, et al. Interim Guidance for Basic and Advanced Life Support in Children and Neonates with Suspected or Confirmed COVID-19. Pediatrics. Published 2020. Accessed January 20, 2021. https://pediatrics.aappublications.org/content/early/2020/04/13/peds.2020-1405 Hunt EA, Jeffers J, McNamara L, et al. Improved Cardiopulmonary Resuscitation Performance with CODE ACES2: A Resuscitation Quality Bundle. Journal of the American Heart Association. Published December 7, 2018. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/JAHA.118.009860 Procedural Pearl of the Month - Fish Hooks Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 20, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Fishing Out the Fishhook. Emergency Medicine News. Published September 1, 2020. Accessed January 20, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=108 Droperidol DeFranco, C, DO. Oldie but a Goodie: 10 Pearls of Droperidol. Acep.org. Published 2021. Accessed January 20, 2021. https://www.acep.org/how-we-serve/sections/pain-management/news/may-2020/oldie-but-a-goodie-10-pearls-of-droperidol/ Ho, J, FAAEM MD, Perkins J, FAAEM MD. Clinical Practice Statement: Safety of Droperidol Use in the Emergency Department. Aaem.org. Published September 7, 2013. Accessed January 20, 2021. https://www.aaem.org/UserFiles/file/Safety-of-Droperidol-Use-in-the-ED.pdf Cisewski, D MD. Droperidol Use in the Emergency Department – What's Old is New Again. Emdocs.net. Published August 1, 2019. Accessed January 20, 2021. http://www.emdocs.net/droperidol-use-in-the-emergency-department-whats-old-is-new-again/ Ken's Third View SGEM#315: Comfortably Numb with Topical Tetracaine for Corneal Abrasions. Thesgem.com. Published January 16, 2021. Accessed January 20, 2021. http://thesgem.com/2021/01/sgem315-comfortably-numb-with-topical-tetracaine-for-corneal-abrasions/ Shipman S, Painter K, Keuchel M, Bogie C. Short-Term Topical Tetracaine Is Highly Efficacious for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial. Ann Emerg Med. Published October 27, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33121832/ SGEM#316: What A Difference an A.P.P. Makes? Diagnostic Testing Differences Between A.P.P.S and Physicians. Thesgem.com. Published January 23, 2021. Accessed January 24, 2021. http://thesgem.com/2021/01/sgem316-what-a-difference-an-a-p-p-makes-diagnostic-testing-differences-between-a-p-p-s-and-physicians/ Pines JM, Zocchi MS, Ritsema TS, Bedolla J, Venkat A, US Acute Care Solutions Research Group. Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain. Acad Emerg Med. Published November 21, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33107088/ Gonorrhea Questions Answered Scully BE, Fu KP, Neu HC. Pharmacokinetics of ceftriaxone after intravenous infusion and intramuscular injection. Am J Med. Published October 19, 1984. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/6093511/ Meyers BR, Srulevitch ES, Jacobson J, Hirschman SZ. Crossover study of the pharmacokinetics of ceftriaxone administered intravenously or intramuscularly to healthy volunteers. Antimicrob Agents Chemother. Published November 1983. Accessed January 20, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC185948/ Shatsky M. Evidence for the use of intramuscular injections in outpatient practice. Am Fam Physician. Published February 15, 2009. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/19235496/ Trivia Question: Send answers to 2viewcast@gmail.com Please note that for this month, if you get the trivia question correct, you will win 20% off any CCME course you want. That's right, ANY CCME course you want. You can buy it for yourself or give it to a friend - it's your 20% off. So, download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com, that's the number 2, view, cast @gmail.com and tell us who you want to give a shout-out to.

  Den Facharzt für Anästhesiologie gibt es erst seit 1953. Vorher gab es zwar auch „Anästhesie“, aber die strukturierte Ausbildung und Prüfung vor Ärztekammern gibt es tatsächlich noch nicht einmal hundert Jahre. Wenn man sich die historische Entwicklung ansieht, stellt man fest, dass in wirklich sehr kurzer Zeit sehr viel passiert ist. Von der Entdeckung … Weiterlesen

What is the most effective agent for relieving nausea and vomiting in the ER? The answer may surprise you…Please click HERE to leave a review of the podcast!References:All references for Episode 42 are found on my Read by QxMD collection

Thank you Jake McRae, OMS IV, for developing this topic. Thank you Rebecca Lee, OMS III, Kodee Rasmussen, OMS III, Haley Shumway, OMS IV, Sadie Larsen, OMS III and Christopher Sauceda, OMS III for participating in this podcast. This is a low yield podcast in terms of principles discussed that help prepare for the shelf exam. It does review the risks and benefits of Droperidol, a medication that is increasingly used in ED settings for agitation, headaches and nausea.

Das Medikament des Monats November ist Droperidol, mal etwas exotischer, aber es gibt spannende Anwendungsmöglichkeiten! Der Beitrag „titriert“ Droperidol erschien zuerst auf pin-up-docs - don't panic.

Droperidol has come back to the market after several years of being unavailable. Today's episode will discuss its potential place in practice, along with practical considerations, such as dosing and monitoring. The information presented during the podcast reflects solely the opinions of the presenter.  The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Happy Thanksgiving! For paramedics, click here for CEU Credits. This year the But Why EMS Podcast is thankful for you, our listeners, for being part of our family.  Thank you! In this episode, we hear about Gina and John's hilarious sedation story and John's personal experience with Versed.   We also have a special guest    Valerie Lew MD who enlightens the crew about the most up to date evidence of sedation usage in the prehospital world! Click here to download! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P   Works Cited "Can you breathe spontaneously through a BVM."  YouTube, Downloaded by Phil Moy, November 28, 2020.  https://www.youtube.com/watch?v=HRgLUAvY7io&t=128s&ab_channel=PaediatricEmergencies. "Curly sleep." YouTube, Downloaded by Phil Moy, November 28, 2020.  https://www.youtube.com/watch?v=fkUPSn7PeV0&ab_channel=auweia1. "Endless rising notes." YouTube, downloaded by Phil Moy, November 28, 2020.  https://www.youtube.com/watch?v=5uXdOnTAxvQ&ab_channel=PhilsTrashchannel. "Hulk Smash & Fight Scenes (2008-2017) MCU| Ragnarok included."  YouTube, Downloaded by Phil Moy, November 28, 2020.  https://www.youtube.com/watch?v=P4QCgtdMFxM&t=233s&ab_channel=CedricDumler. Isenberg DL, Jacobs D. Prehospital Agitation and Sedation Trial (PhAST): A Randomized Control trial of Intramuscular Haloperidol versus Intramuscular Midazolam for the Sedation of the Agitated of Violent Patient in the Prehospital Environment. Prehospital Disaster Medicine. 2015 Oct; 30 (5):491-5. Doi.10.1017. Epub 2015 Sep 1. https://www.ncbi.nlm.nih.gov/pubmed/26323511. "Lou Reed-Perfect Day (Audio)."  YouTube, downloaded on November 28, 2020. https://www.youtube.com/watch?v=9wxI4KK9ZYo&ab_channel=LouReedVEVO Macht M, Mull A, McVaney K, et al. Comparison of Droperidol and Haloperidol for Use by Paramedics: Assessment of Safety and Effectiveness. Prehospital Emergency Care. 2014; 18:3, 375-380. https://doi.org/10.3109/10903127.2013.864353 Martel M, Miner J, Fringer R, et al. Discontinuation of Droperidol for the Control of Acutely Agitated Out of Hospital Patients. 2009; 9:1, 44-48. https://doi.org/10.1080/10903120590891723. Page C, Parker L, Rashford S,et al. A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance. Prehospital Emergency Care. 2018; 22:6, 713-721. https://doi.org/10.1080/10903127.2018.1445329 "Relaxing Music and Calming 4K Waterfall nature: Sleep Relaxation."  YouTube, downloaded by Phil Moy, November 28, 2020, https://www.youtube.com/watch?v=xJ4hsUE9zU8&ab_channel=321Relaxing-MeditationRelaxClips. Thomas H, Schwartz E, Petrilli R. Droperidol versus haloperi- dol for chemical restraint of agitated and combative patients. Ann Emerg Med. 1992;21(4):407–13. "To alcohol...the cause of...and solution to...all of life's problem's."  YouTube, downloaded by Phil Moy, November 28, 2020.  https://www.youtube.com/watch?v=hUVwR0rw5fk&ab_channel=Jappana.  

This episode was a LIVE media broadcast discussing a double-blind trial of IM Droperidol, Ziprasidone and Lorazepam for acute undifferentiated agitation in the emergency department. Join Mike and Jeff as they discuss the paper, take questions from the viewers and tease the newly released Standard of Care Podcast! Thank you for listening, sharing, rating and reviewing all the FlightBridgeED podcasts! We appreciate you being on this journey with us!

Unsere neue Folge ist da! Themen sind Porphyrie, Covid-19-Therapie, Heparin induzierte Thrombozytopenie, Droperidol und natürlich unsere etablierter Journal Club. Viel Spaß beim hören ! Kommentare Vermischtes Robert Enke Stiftung Nobelpreise https://www.nobelprize.org/prizes/medicine/2020/prize-announcement/ https://www.nobelprize.org/prizes/chemistry/2020/summary/ S.I.G.N.A.L. – e.V. http://signal-intervention.de/signal-leitfaden http://signal-intervention.de/materialien-fuer-fachkraefte Journal Club Iacobucci G. Covid-19: Risk of death more than doubled in people who also had flu, English data show. BMJ. 2020 Sep […] Der Beitrag Podcast November 2020 – Folge 22 erschien zuerst auf pin-up-docs - don't panic.

Show notes at pharmacyjoe.com/episode557. In this episode, I’ll discuss the use of droperidol for acute agitation in the ED. The post Episode 557: Droperidol for Acute Agitation – A Comeback Story? appeared first on Pharmacy Joe.

It’s the JournalFeed Podcast for the week of Oct 26-30, 2020. We cover influenza and COVID-19 co-infection, best tests for septic arthritis, EAST AF-NET4 early rhythm control for atrial fibrillation, what fractures at what ages should increase concern for child abuse, and a trial of droperidol vs. ziprasidone, vs. lorazepam for agitation.

Contributor: Sam Killian, MD Educational Pearls: Droperidol (Inapsine) is an antipsychotic drug with efficacy for  nausea, vomiting, headaches, and treating agitation In the early 2000’s, Droperidol received a black box warning for QT prolongation This caused a precipitous drop of in administration and ultimately led to a stop in production More careful analysis since has called into question the true incidence of QT prolongation in typical dosing Retrospective review published this year looked at 15,374 non-critical and 1,172 critical patients who received droperidol with only a single episode of Torsades des pointes (which was attributed to multiple other risk factors) Of the 2,431 non-critical patients, and 396 critical patients, who received an ECG before and after administration, there were no changes to the mean QTc Droperidol is being manufactured again and the prior black box warning being called into question, so it will likely begin to become more widely available for use References Cole JB, Lee SC, Martel ML, Smith SW, Biros MH, Miner JR. The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department. West J Emerg Med. 2020 Jul 2;21(4):728-736. doi: 10.5811/westjem.2020.4.47036. PMID: 32726229; PMCID: PMC7390553. Perkins J, Ho JD, Vilke GM, DeMers G. American Academy of Emergency Medicine Position Statement: Safety of Droperidol Use in the Emergency Department. J Emerg Med. 2015 Jul;49(1):91-7. doi: 10.1016/j.jemermed.2014.12.024. Epub 2015 Mar 30. PMID: 25837231. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD  

In this episode, we discuss the use of droperidol for the treatment of agitation in the ER setting. Please remember to subscribe to our podcast and leave us a comment! References:Knott JC, et al. Randomized clinical trial comparing intravenous midazolam and droperidol for sedation of the acutely agitated patient in the emergency department. Ann Emerg Med. 2006; 47: 61-67Isbister GK, et al. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med. 2010; 56: 392-401Chan EW, et al. Intravenous droperidol or olanzapine as adjunct to midazolam for the acutely agitated patient: a multicenter, randomized, double-blind, placebo-controlled clinical trial. Ann Emerg Med. 2013; 61: 72-81Taylor, DM, et al. Midazolam-droperidol, droperidol, or olanzapine for acute agitation: a randomized clinical trial. Ann Emerge Med. 2017; 69(3): 318-326Olanzapine (Zyprexa) [prescribing information]. Princeton, NJ: Sandoz; 2019

RSI, chemical restraint, or physical restraint? In this podcast episode, we are joined by ED and Flight Nurse Nyssa Hattaway at AMTC19 to discuss medical management and aircraft safety considerations surrounding the patient with acute agitation, excited delirium, and/or drug-induced psychosis. We also touch on Droperidol; an old drug that is finding its way back into the Pyxis and hearts of emergency providers everywhere. ------------------------------------------------  Twitter @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet YouTube /heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed during the Heavy Lies the Helmet, LLC podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information contained in the podcast series available for listening or reading on this site. The primary purpose of this podcast series is to educate and inform. This podcast series does not constitute other professional advice or services. ------------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com Creative Commons Attribution 3.0 Unported License https://creativecommons.org/licenses/by/3.0/deed.en_US Metalicious by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

Mike and Ritu bring Dr. Jarvis in the mix for the "cross over episode of the century"…um, described by Mike as a ménage a trois…it's not like that…he just meant it's a 3 for one…even that doesn't sound right. He is simply saying how often do you get 2 AMAZING EMS Physicians on the same pod at the same time!? We tackle DROPERIDOL!! Remember that medication? It's was an amazing drug that lost its way. WE talk about why and how it's making a comeback. Still considered one of the top 10 in the industry, we couldn't do it without your support! Thank you for the comments, reviews and emails! If you haven't, please go to your favorite podcast app and leave a rating and review! We appreciate it!

Mike and Ritu bring Dr. Jarvis in the mix for the "cross over episode of the century"…um, described by Mike as a ménage a trois…it's not like that…he just meant it’s a 3 for one…even that doesn't sound right. He is simply saying how often do you get 2 AMAZING EMS Physicians on the same pod at the same time!? We tackle DROPERIDOL!! Remember that medication? It's was an amazing drug that lost its way. WE talk about why and how it's making a comeback. We appreciate you listening to the SecondShift podcast! Still considered one of the top 10 in the industry, we couldn’t do it without your support! Thank you for the comments, reviews and emails! If you haven’t, please go to your favorite podcast app and leave a rating and review! We appreciate it!

We discuss the US Food & Drug Administration's black box warning for droperidol and the evidence behind this warning. We then discuss the use of butyrophenones such as droperidol and haloperidol for the treatment of agitation, headaches, nausea and vomiting, and gastroparesis/cannabinoid hyperemesis.   Thanks for listening! Jeremy Faust and Lauren Westafer 

One of the stress points when a patient taking chronic opioids presents with acute pain is that we feel we have little to offer them. Are more opioids the answer? That's often what happens, but might not be the best next step. In this episode, Reuben Strayer presents the argument in favor of haloperidol for analgesia and why more opioids can do more harm than good.    Episode Guide In the introduction, preview of a project we're working on for Essentials of Emergency Medicine (May 15-17). Opioid induced hyperalgesia: compared to those not taking opioids, patients on chronic opioids may have a more unpleasant experience when exposed to painful stimuli. In other words, they are more sensitive pain. The meds used to treat pain, actually worsen pain. A patient who uses chronic opioids will have marginal gains in analgesia with escalating doses while getting closer to potentially lethal adverse effects. Haloperidol is an analgesic option for patients taking chronic opioids. Reuben's strategy for using haloperidol for analgesia in chronic opioid patients: 10 mg IM haloperidol if there is no IV,  5 mg IV if they have a line. If they don't fall asleep shortly after (or have improvement of pain) he repeats the dose.  If that doesn’t work, he uses analgesic dose ketamine. For analgesic dose ketamine in these patients, Reuben uses 30 mg IV. This may cross over into the 'recreational' or 'partial dissociation' dose where the patient can have disturbing psycho-perceptual effects. He has found that the pretreatment with haloperidol leads to less distress from these psycho-perceptual effects. For more information on ketamine dosing, see Reuben's post on the Ketamine Brain Continuum. Haloperidol and the prolonged QTc: Butyrophenones (of which haloperidol is one) are known to prolong the QTc. Should we get an EKG prior to giving haloperidol to see if the QTc is already prolonged? Reuben feels that the negative effects of butyrophenone QTc prolongation are overblown and does not routinely get an EKG prior to giving haloperidol. This includes initial and subsequent doses.  Take that with a grain of salt because there are many docs who do get an EKG before the first or second dose of haloperidol, especially if there is a known QTc prolonging drug on the patient's med list (like methadone). Some hospitals even have policies that before a second dose is given, there is a hard stop for EKG and QTc check. Check out Reuben's blog Emergency Medicine Updates and follow him on Twitter   References Opioid Hyperalgesia Marion Lee, M., et al. "A comprehensive review of opioid-induced hyperalgesia." Pain physician 14 (2011): 145-161 Full text link. PMID: 21412369  Hooten, W. Michael, et al. "Associations between heat pain perception and opioid dose among patients with chronic pain undergoing opioid tapering." Pain Medicine 11.11 (2010): 1587-1598 Full text link.  PMID: 21029354 Droperidol for analgesia Richards, John R., et al. "Droperidol analgesia for opioid-tolerant patients." Journal of Emergency Medicine 41.4 (2011): 389-396.  PMID: 20832967 Amery, W. K., et al. "Peroral management of chronic pain by means of bezitramide (R 4845), a long-acting analgesic, and droperidol (R 4749), a neuroleptic. A multicentric pilot-study." Arzneimittel-Forschung 21.6 (1971): 868. PMID: 5109279 Admiraal, P. V., H. Knape, and C. Zegveld. "EXPERIENCE WITH BEZITRAMIDE AND DROPERIDOL EN THE TREATMENT OF SEVERE CHRONIC PAIN." British journal of anaesthesia 44.11 (1972): 1191-1196. PMID: 4119073 Early studies on Haloperidol for analgesia Maltbie, A. A., et al. "Analgesia and haloperidol: a hypothesis." The Journal of clinical psychiatry 40.7 (1979): 323-326. PMID: 222741 Cavenar, Jo, and A. A. Maltbie. "The analgesic properties of haloperidol." US Navy Med 67 (1976): 10. Cavenar, Jesse O., and Allan A. Maltebie. "Another indication for haloperidol." Psychosomatics 17.3 (1976): 128-130. Haloperidol for pain Seidel, Stefan, et al. "Antipsychotics for acute and chronic pain in adults." Cochrane Database Syst Rev 4 (2008). PMID: 18843669 Ramirez, R., et al. “Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department.” The American journal of emergency medicine (2017). PMID:28320545 Reviewed in this ERCast episode Salpeter, Shelley R., Jacob S. Buckley, and Eduardo Bruera. "The use of very-low-dose methadone for palliative pain control and the prevention of opioid hyperalgesia." Journal of palliative medicine 16.6 (2013): 616-622. PMID: 23556990 Afzalimoghaddam, Mohammad, et al. "Midazolam Plus Haloperidol as Adjuvant Analgesics to Morphine in Opium Dependent Patients: A Randomized Clinical Trial." Current drug abuse reviews 9.2 (2016): 142-147. PMID: 28059034

Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

Danger, Disruption, and Reub Strayer

Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

This week we discuss pearls from a talk from Reuben Strayer on sedation of the agitated patient focusing on patient and staff safety. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_56_0_Final_Cut.m4a Download 3 Comments Tags: Agitation, Droperidol, Excited Delirium, Haloperidol, Lorazepam, Midazolam Show Notes

This week we discuss pearls from a talk from Reuben Strayer on sedation of the agitated patient focusing on patient and staff safety. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_56_0_Final_Cut.m4a Download 3 Comments Tags: Agitation, Droperidol, Excited Delirium, Haloperidol, Lorazepam, Midazolam Show Notes

This week we discuss pearls from a talk from Reuben Strayer on sedation of the agitated patient focusing on patient and staff safety. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_56_0_Final_Cut.m4a Download 3 Comments Tags: Agitation, Droperidol, Excited Delirium, Haloperidol, Lorazepam, Midazolam Show Notes