Versed vs. Ativan

We also need to consider the possibility of hyperkalemia in this patient (assuming hemodialysis). The "ECG wnl" is reassuring... but is this a 12-lead or 3-lead, and how are our T waves looking?

I would argue that sedation/analgesia should be to facilitate transport in as small a dose as possible, and we should avoid upsetting the apple cart unless we have a very long transport time, e.g. hours + to dialysis, or strong evidence of critical hyperkalemia.
 
Conanboris said:
Was just wondering on this? It's the first time I'd heard that and I best of my recollection, fentanyl is excreted predominantly in the urine (somewhere around 70-75%). Fecal excretion is much lower (around 10%)..

As always, I stand correctly and am really just here to learn...
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stand CORRECTED ... not correctly... d'oh
 
Interesting discussion.

I wouldn't have thought of Fentanyl - and these days, it's damn near non-existent on our rigs anyway.

PA has some decent protocols - including the "combative patient" option where we can snow the heck out of the guy to keep them and us safe.


I'd have discussed switching to Versed w/ the doc after 2mg Ativan didn't stop it. And yeah, if I had a longer transport, considering opioids and Benadryl to attempt to make the situation safe for me and the pt. makes sense.
 
Conanboris said:
Was just wondering on this? It's the first time I'd heard that and I best of my recollection, fentanyl is excreted predominantly in the urine (somewhere around 70-75%). Fecal excretion is much lower (around 10%)..

As always, I stand correctly and am really just here to learn...
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just found this, sorry for the delay.

The numbers are different depending on whether you are measuring metabolites, unmetabolized, oral, or transdermal routes.

Honestly I have been told in the clinical environment that fent is better for dialysis patients because it is excreted fecally. I can find no literature on this.

After looking into it deeper, after seeing this post, it appears to be metabolized into inert metabolites faster and in greater quantity, so I am of the mind that it is the metabolism and not the excretion that makes a difference.

Please forgive my earlier statement as not entirely accurate.

Fent is still going to be superior to other agents in terms of toxicity in the renal compromised.
 
Emtpbill said:
So Friday night I am 20 hours into a 24 hour tour. Get hit out for seizures. Arrive o/s with 3 pd officers to find a 50 yom sitting on a computer desk chair that is on wheels. Family sts that they were awakened by pt not acting right and talking disoriented. Wife says she had to "wrestle with pt to get him to sit". He is leaning against a wall. Family sts he is a IDDM who also has dialysis 3 times a week but didn't go today cause his ride never came. When I try to talk to pt all he says is I want a drink of water.
Glucometer shows BS at Hi, doesn't give a number. Try to wheel chair to steps but it doesn't move. Get the reeves set up an pt onto it, pt starts to seize, approx 15 seconds grand mal.
Expedite to MICU . Hi flo 02, vitals EKG. All wnl.
Pt arms are scarred from years of IV drug use. Finally am able to thread a 20 in the right internist vein.
NSS wide to try to dilute the sugar(I know not really helpful, but he needs insulin and I don't have any).
Anyways halfway into a 25 minute transport time he starts to become combative. I am alone in back and PD is too far to rendezvous.
So I give Ativan. 1mg, vitals. Another 1mg and so on. Call command and give report. Total of 4mg ativan and this guy is still combative.
Would I have been better to have gone with versed. I have only used versed to facilitate intubation an that was about 10 years ago. Worked great 5mg but that was on a 100 lb. woman.
What's is everyone's experience with using versed for seizures or to settle down combativeness.


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I am here: http://maps.google.com/maps?ll=40.089019,-74.979306
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Versed or Valium ALL DAY! I hate Ativan and I think it should be take off the truck!
 
Is there a basis for your statement or is it simply opinion?
 
Hi all, new here so bare with me haha

But i've given Versed IM before and it worked fast and had the desired effect, the only down side i'd say is the short half life, we had a 25min transport and had to give a repeat dose a couple of times.
 
Hope I don't get scolded for dredging up an old thread, but I didn't see much point in creating a new one. This is a good thread.

For those who give Versed for chemical restraint, does anyone have any experience or feedback with regards to periods of apnea, s/p administration?
 
Off the normal 2.5-5mg doses I've given for combative people, I've not really experienced a severely depressed respiratory drive.


If it happens, they get bagged for a few minutes.
 
Linuss said:
Off the normal 2.5-5mg doses I've given for combative people, I've not really experienced a severely depressed respiratory drive.


If it happens, they get bagged for a few minutes.
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Right. I just was wondering how often it happens. An RN told me it was quite common.
 
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EMSrush said:
For those who give Versed for chemical restraint, does anyone have any experience or feedback with regards to periods of apnea, s/p administration?
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Not sure what "s/p" means?

I've used it quite a lot, and have had no problems (I have made a couple of people apneic with IV lorazepam). If you're giving it IV, the onset is fairly rapid, and it's quite titratable, so if you keep in mind that the goal is to facilitate appropriate physical restrain, and limit physiologic stress to the patient, verus knocking them completely out, then I think you're going to be ok.

Unfortunately, like anything, when the patient's taken other agents, prescribed or not, it becomes less predictable, but that's a given, right?
 
EMSrush said:
Right. I just was wondering how often it happens. An RN told me it was quite common.
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How much are they giving? Our system regularly gives 5 of versed, 5 of haloperidol and 50 of diphenhydramine for sedation (in the elderly population mind you) and we've yet to experience a respiratory arrest. I've been giving benzodiazepines and opiates together for years and haven't done this.

I HAVE seen a lot of respiratory rates to down significantly, but mostly this was simply a return to an acceptable range, no apnea observed
 
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mycrofft said:
FOG hint #1: bystanders call everything from waking up from a faint to a grand mal, to orgasm, a seizure.
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Awesomely quotable :)
 
I understand that ETOH will potentiate the effects, but this is the first time I've seen apnea. Was just looking for some feedback on experiences.
 
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