Affective or psychotic agitation in younger children 3-16 y/o, what's your go to IM? 5/2/2 [haldol/Ativan/benadryl]? Thorazine? zyprexa? ativan?
That’s funny but yet so representative of how we conceptualize medicine. I’m trying to think how this scenario wouldn’t have been worse with Zyprexa or another antipsychotic. It’d be like having a lawsuit with benzos so to avoid that in the future you just give barbs.I think we may have been involved in a lawsuit that was connected to diphenydramine for sedation at some point and so it is strictly verboten.
What would you give?are you srsly giving 3yr olds B52s, zyprexa and thorazine?! no wonder people hate psychiatrists
I know this question isn’t posed to me but this becomes an institutional problem. Nursing staff initially notice a problem and request an intervention. They’re conditioned to having request met with the patient being slammed with some Zyprexa/Haldol/Thorazine/whathaveyou and notice significant reduction in their occupational anxieties. If you come in and go against the rest of conventional wisdom, get ready for being the ignorant physician and prepare yourself for nocebo by proxy. The question isn’t really what would you give instead, the question is how you will deal with the inevitable fallout of not ‘adequately’ addressing the issue, and that’s a much larger problem than the acute issue before you. It’s a lose-lose-win situation where the patient, temporarily, benefits.What would you give?
The point at which behaviors become dangerous to self/others is again a threshold highly dependent on the quality of your nursing staff, and, more importantly, your administration’s support for appropriate nursing staff. I know this is vague, but the real answer is to not practice in the environments that are toxic to staff and patients because ultimately it doesn’t matter what you do.I hope this goes without saying here. The assumption is you treat the underlying cause of agitation and not just sedating the child, e.g. hyperactivity and impulsivity treat with a stimulant and maybe standing risperidone. And of course, verbal redirection and behavioral plans, and all other non psychotropic interventions. But, when those things do not work and the child is so out of control that they might actually hurt themselves or staff, what medication do you prefer to use? Obviously, this is not ideal and only to address the immediate safety or psychosis until the appropriate behavioral plan is in place or meds are figured out.
Exactly this. Restraint situations are stressful for everyone involved--security, all of nursing, other patients on the unit. What you do is as much to treat the milieu as to treat the individual patient.I know this question isn’t posed to me but this becomes an institutional problem. Nursing staff initially notice a problem and request an intervention. They’re conditioned to having request met with the patient being slammed with some Zyprexa/Haldol/Thorazine/whathaveyou and notice significant reduction in their occupational anxieties. If you come in and go against the rest of conventional wisdom, get ready for being the ignorant physician and prepare yourself for nocebo by proxy. The question isn’t really what would you give instead, the question is how you will deal with the inevitable fallout of not ‘adequately’ addressing the issue, and that’s a much larger problem than the acute issue before you. It’s a lose-lose-win situation where the patient, temporarily, benefits.
You are right. But let's assume that this is that rare situation where the child would benefit from medication. What would you choose? and how do you think through your medication options?The point at which behaviors become dangerous to self/others is again a threshold highly dependent on the quality of your nursing staff, and, more importantly, your administration’s support for appropriate nursing staff. I know this is vague, but the real answer is to not practice in the environments that are toxic to staff and patients because ultimately it doesn’t matter what you do.
You are right. But let's assume that this is that rare situation where the child would benefit from medication. What would you choose? and how do you think through your medication options?
One of the local, extremely poor quality hospitals in this area is now being sued for giving kids "booty juice" - yes, they actually called it this, and yes, referred to "emergency" IMs as this to the kids - inappropriately and in the absence of a true emergency indication. They're regimen included the usual haloperidol/lorazepam/diphenhydramine at various doses.
I'll admit I know next to nothing about child psych, but when I did a month on the inpatient unit the preferred emergency medication was ziprasidone. I can't remember hearing any kids ever receiving emergency medications when I was there, however. The unit staff much preferred behavioral interventions, and even with the occasional psychotic patient those interventions were effective enough to at least prevent the use of IM meds.