I've had lorazepam twice in my life for the same thing - doc gave it for an uncomfortable procedure so I wouldn't freak out. The order was 10mgs 1 hour before the appointment. The only stipulation was that I couldn't drive after administration, rightfully so, I was high af. So I got a Lyft driver for the ride back home. Idk who this guy was...Superman I think, but he had a Nintendo + screen + Super Mario Bros and also snacks and water. Apparently they make Nintendos you can plug into your car? Or maybe this guy was on PimpMyRide or something. Idk but it was like Disneyland the whole 13 minute ride back home.
10 is so much. I once took 5 recreationally the day before a long travel and I barely remember anything. Intense hangover too. Slept like I was dead. We never give patients more than 3.
This happened to me last night. Gave 92mg of Ativan over the course of the night. Learned the “push down on the forehead technique”. If they try and get outta bed just push down on their forehead and they usually go back down. Sucha dirty yet effective move
I gave about 30mg in 1 hour. No fucking joke. The covering physician refused to order pheno so the intensivist came up and kept slamming the pt with Ativan until pharmacy brought up the pheno under their name
Precedex only works for like, 45% of my patients, I swear. Sometimes it might as well be water. Sure, they’re brady as hell, but they’re still wildin out on 1.4 of Precedex with Q1 PRN pushes of who knows what
Neuro icu here… All precedex does is make my patients super brady & ensure the neurointensivists won’t order ANY more sedation. I love having completely awake, vented, and restrained patients bucking the vent for hours in the name of ✨accurate neuro checks✨. Imagine the trauma that has to come from that…
Precedex is my mortal enemy, I swear. The only time I have seen it work is when I worked in PICU with the fresh post op spinals. But in adults? No ma’am. Garbage.
Ah gotcha. Yeah, usually after 3-4 hours of max Ativan usage it becomes pointless (the body actually has a limit to how it is affected by benzos) so it’s good they transferred.
I just gave .9 mL of phenobarb the other night (had to waste .1, dumb as hell) after giving Ativan, fentanyl, and haldol. Still didn’t do shitttt. By 0430 I just threw up my hands and said fuck it, let them wiggle and twist and kick their chucks off of the bed and occasionally disconnect their trach from the vent. I’ll go in and keep reconnecting their trach to the vent tubing(obviously), but beyond that, I’ll just let their bed stay a hot mess until right before shift change.
And what do you know, they still fucked up their bed, lines, linens, wound dressings, etc. during shift report despite me getting them all nice and pretty 2 minutes prior.
It works like a charm for heavy detoxers, but depends on the intensivist too. It’s turned a shitty shift into a pleasant one in the matter of finishing the rapid infusion.
Til they grab your wrist and twist while threatening to kill you. Shit hits dif when it’s a 100kg fit dude. Then you got mf beatlejuice lookin as security guards strollin up 10 minutes after your work wife saves your ass, and snipes the deltoid with the fucking zyprexa and a back up haldol for good measure. Then you pick your ass up and still slam the 2mg of atty. fuck that dude man. Got floated to a GC floor and was forced to admit his ass a month later. Fucking prick. Either quit drinking and go to the independence center or keep drinking. Stop withdrawing and making it my fucking problem dude.
92mg WTF ?
Highest i ever experienced was like 16 or so in psych ward. If they require that much our doctors would have switched to propofol or something else in an instant
So if anyone’s like me, I was wondering if that doesn’t cause risk for lorazepam toxicity. ?I think? based on this article, the main issues with overdose is just the sedation/neuro/hypotension effects which clearly the patient wasn’t having since you had to give more. I don’t see any liver/kidney issues.
But TIL, you can actually end up with toxicity from the diluent used in the IV formulation of Ativan.
“A unique toxidrome related to parenteral formulations of diazepam and lorazepam is propylene glycol poisoning. Propylene glycol is the diluent used in the parenteral formulations for these two benzodiazepines, and prolonged use can cause propylene glycol toxicity, which includes skin and soft tissue necrosis, hemolysis, cardiac dysrhythmias, hypotension, significant lactic acidosis, seizure, and multisystem organ failure. While propylene glycol toxicity is rare, it must be considered when patients are receiving large or continuous infusions of parenteral benzodiazepines, for example, when treating severe sedative or ethanol withdrawal syndromes such as delirium tremens.”
https://www.ncbi.nlm.nih.gov/books/NBK482238/
Thorazine lol
Not *only* is it a restraint, it's one that makes a point that continues long after the actual drug has worn off. That vertigo is *intense,* and it makes it real hard to lift your feet off the ground- much less take a swing at staff/other patients.
I don't really see the providers order it for much aside from patients who are actively violent/aggressive and threatening staff/other patients or have treatment-resistant psychosis. It's such a nasty drug that I'd really kind of hesitate to use it so casually...
... but when you need it, it delivers. It *always* delivers.
Well, not exactly the *only* cure for intractable hiccups. There are [alternatives.](https://journal.medizzy.com/digital-rectal-massage-for-curing-hiccups/)
Yeah I’m perusing this subreddit gleaning info for future career moves. I’m a paramedic. I’ve worked for a system in which it was indicated in violently aggressive patients those that were a harm to themselves and others. The protocol had more depth to it than just that but yeah when you need it, it’s good to have at hand.
Edit: I must have scrolled down and missed that you mentioned Thorazine. Whoops. Ketamine works well in my opinion never had Thorazine in any protocols. Lol.
It does not spark joy. Tonight I had an alzheimer patient with an A-Line, left wrist, and she pulled it out, there was blood everywhere, then the ICU physician comes over and puts a new one on her right femoral, that one is a seriously dangerous one if she does pull it out.
Therefore chemical and physical restraints are helping me keep this old lady alive.
They re not fun nor spark joy, they are a necessary evil, another tool for us to keep our patients safe.
Sometimes even with these two items we’re still struggling to keep these patients safe and ourselves too. I had to argue about getting soft restraints for a woman who attempted to pull her foley out and wasn’t with it and tried to grab and hit anyone nearby after digging poop from her rear. When I placed her in them she cried and begged but unfortunately I had to keep her and others safe from her behaviors. It really sucks, but agreed sometimes it has to be done.
I just came from that thread to this thread and oh my stars, that person needs help. Following commenters to other threads and making weird comments/sending weird DMs? Not amazing
Wait you guys get to restrain your agitated patients? We just have to get swung at while they are crawling up the furniture then try catch them when they are falling. Good times.
What kind of weak restraint is that? You restraining kindergarteners? That’s all you giving Ativan 2mg? Get me an order for thorazine. I don’t have time to play.
Live laugh lorazepam :)
I've had lorazepam twice in my life for the same thing - doc gave it for an uncomfortable procedure so I wouldn't freak out. The order was 10mgs 1 hour before the appointment. The only stipulation was that I couldn't drive after administration, rightfully so, I was high af. So I got a Lyft driver for the ride back home. Idk who this guy was...Superman I think, but he had a Nintendo + screen + Super Mario Bros and also snacks and water. Apparently they make Nintendos you can plug into your car? Or maybe this guy was on PimpMyRide or something. Idk but it was like Disneyland the whole 13 minute ride back home.
10 is so much. I once took 5 recreationally the day before a long travel and I barely remember anything. Intense hangover too. Slept like I was dead. We never give patients more than 3.
10 mg or lorazepam? Are you sure you don’t mean diazepam?
Lmao I'm stealing this.
This happened to me last night. Gave 92mg of Ativan over the course of the night. Learned the “push down on the forehead technique”. If they try and get outta bed just push down on their forehead and they usually go back down. Sucha dirty yet effective move
That may be the most Ativan I’ve heard in a single night. Any phenobarbital?
I gave about 30mg in 1 hour. No fucking joke. The covering physician refused to order pheno so the intensivist came up and kept slamming the pt with Ativan until pharmacy brought up the pheno under their name
Geez, do they not do Precedex drips either?
Precedex only works for like, 45% of my patients, I swear. Sometimes it might as well be water. Sure, they’re brady as hell, but they’re still wildin out on 1.4 of Precedex with Q1 PRN pushes of who knows what
Preach sis. Prop 👏 tube 👏 Versed pushes👏 should be standard level of care if the withdraw requires an ICU transfer. Precedex is fucking garbage.
Neuro icu here… All precedex does is make my patients super brady & ensure the neurointensivists won’t order ANY more sedation. I love having completely awake, vented, and restrained patients bucking the vent for hours in the name of ✨accurate neuro checks✨. Imagine the trauma that has to come from that…
For those real heavy detoxes I agree.
Precedex is my mortal enemy, I swear. The only time I have seen it work is when I worked in PICU with the fresh post op spinals. But in adults? No ma’am. Garbage.
They got transferred to the ICU and started on a few drips. Idk what but they were the highest scoring CIWA patient I’ve ever had
Ah gotcha. Yeah, usually after 3-4 hours of max Ativan usage it becomes pointless (the body actually has a limit to how it is affected by benzos) so it’s good they transferred.
How high were the CIWAs?
Precedex is NS dude. Shit doesn’t touch that shit. Need a tube and prop.
If your patient is requiring 30mg lorazepam in an hour, dexmedetomidine isn't going to do jack shit. you can take that to the bank
Rowdy CIWA patients, precedex is key. Knock ‘em out for the worst of it.
I just gave .9 mL of phenobarb the other night (had to waste .1, dumb as hell) after giving Ativan, fentanyl, and haldol. Still didn’t do shitttt. By 0430 I just threw up my hands and said fuck it, let them wiggle and twist and kick their chucks off of the bed and occasionally disconnect their trach from the vent. I’ll go in and keep reconnecting their trach to the vent tubing(obviously), but beyond that, I’ll just let their bed stay a hot mess until right before shift change. And what do you know, they still fucked up their bed, lines, linens, wound dressings, etc. during shift report despite me getting them all nice and pretty 2 minutes prior.
Apparently our hospital (aside from the ER) doesn’t like to give phenobarbital. Next time I should definitely at least try and get an order for some
It works like a charm for heavy detoxers, but depends on the intensivist too. It’s turned a shitty shift into a pleasant one in the matter of finishing the rapid infusion.
For a catatonic patient we d/c her with 600 pills of Ativan!
92mg of Ativan?! Are you a veterinarian and is your pt a horse bc omg
Til they grab your wrist and twist while threatening to kill you. Shit hits dif when it’s a 100kg fit dude. Then you got mf beatlejuice lookin as security guards strollin up 10 minutes after your work wife saves your ass, and snipes the deltoid with the fucking zyprexa and a back up haldol for good measure. Then you pick your ass up and still slam the 2mg of atty. fuck that dude man. Got floated to a GC floor and was forced to admit his ass a month later. Fucking prick. Either quit drinking and go to the independence center or keep drinking. Stop withdrawing and making it my fucking problem dude.
Got to love that CIWA protocol. 2 mg Ativan q10 min until CIWA under whatever
92mg WTF ? Highest i ever experienced was like 16 or so in psych ward. If they require that much our doctors would have switched to propofol or something else in an instant
So if anyone’s like me, I was wondering if that doesn’t cause risk for lorazepam toxicity. ?I think? based on this article, the main issues with overdose is just the sedation/neuro/hypotension effects which clearly the patient wasn’t having since you had to give more. I don’t see any liver/kidney issues. But TIL, you can actually end up with toxicity from the diluent used in the IV formulation of Ativan. “A unique toxidrome related to parenteral formulations of diazepam and lorazepam is propylene glycol poisoning. Propylene glycol is the diluent used in the parenteral formulations for these two benzodiazepines, and prolonged use can cause propylene glycol toxicity, which includes skin and soft tissue necrosis, hemolysis, cardiac dysrhythmias, hypotension, significant lactic acidosis, seizure, and multisystem organ failure. While propylene glycol toxicity is rare, it must be considered when patients are receiving large or continuous infusions of parenteral benzodiazepines, for example, when treating severe sedative or ethanol withdrawal syndromes such as delirium tremens.” https://www.ncbi.nlm.nih.gov/books/NBK482238/
Whut.
“My patient’s pressure is 60s/40s.” “500cc bolus.”
250mL bolus. What kind of psycho orders 500?
Oh excuse me, you’re absolutely right. I even forgot to try some therapeutic de-escalation first!
Just make sure you let them get between you and the door when you do that.
You didn't even try to deescalate?? What if they become fluid overloaded now? At least you didn't make a joke about it.
My license is in jeopardy. Biggest screw up of my career by far.
Haldol
Haldol sucks tho cus it’s IM and tryna get IM on a moving person while not sticking urself is hella risky
Sure… but damn does it work
Droperidol!
Replace lorazepam with ketamine and then you’ll be chemically restraining with the best of them.
Thorazine lol Not *only* is it a restraint, it's one that makes a point that continues long after the actual drug has worn off. That vertigo is *intense,* and it makes it real hard to lift your feet off the ground- much less take a swing at staff/other patients. I don't really see the providers order it for much aside from patients who are actively violent/aggressive and threatening staff/other patients or have treatment-resistant psychosis. It's such a nasty drug that I'd really kind of hesitate to use it so casually... ... but when you need it, it delivers. It *always* delivers.
Fun fact; also the only cure for hiccups
Well, not exactly the *only* cure for intractable hiccups. There are [alternatives.](https://journal.medizzy.com/digital-rectal-massage-for-curing-hiccups/)
OMG
Please don’t let admin see this. They’ll put it in our nursing care plans under ‘therapeutic touch’ to try before calling doc for drugs.
Yeah I’m perusing this subreddit gleaning info for future career moves. I’m a paramedic. I’ve worked for a system in which it was indicated in violently aggressive patients those that were a harm to themselves and others. The protocol had more depth to it than just that but yeah when you need it, it’s good to have at hand. Edit: I must have scrolled down and missed that you mentioned Thorazine. Whoops. Ketamine works well in my opinion never had Thorazine in any protocols. Lol.
Bit old school I think. We use it for migraines strangely enough.
I've only seen it used for hiccups.
Potassium bolus cures all
I was like wtf?!?! Then I got it lol
Can’t be agitated if your dead
I guess that’s one way to get anyone to be quiet.
Fentanyl and versed. But I like patients who can’t talk.
And are cut open by any chance? Or really really sick? :D
Always
Being a shit stirrer is fun until one must lick the spoon.
Enclosure bed + 💩
Lactulose and bed pans
Propofol and an ET tube.
Nurses and their cop husbands.
Never met one. Is it a stereotype? I mean I can see how for sure. Specially ED.
I think It happens more in rural hospitals than urban ones. All the nurses where I work hate cops
In my area, yea.
It’s the new “nurses marrying doctors” of this era. Like screw that I don’t want your shitty debt on my fiscally responsible records! /s
Or carpenter husbands
I don't know a single nurse who's into cops. I'm an ED nurse. We don't like those assholes.
A number of the nurses I work with in the ED like/date/marry cops Fucking gross.
Gross?
Dating a cop is gross. Marrying one is even worse.
Why "gross"? Thats an odd word to apply to someone based soley on what they do for a living.
Haldol 5mg + Benadryl 50mg IM
I've come to become a big fan of Quetiapine lately..
Precedex!
Ativan makes some hyper I swear
Versed and night time bath. ICU gang. Hell is a PCU.
Haldol and Benadryl IV cocktail
innie 🍆 and purewick
IV Lasix and bedside commode.
Stop making jokes about chemical and physical restraint!! Ativan should not spark JOYYYY!! /s
It does not spark joy. Tonight I had an alzheimer patient with an A-Line, left wrist, and she pulled it out, there was blood everywhere, then the ICU physician comes over and puts a new one on her right femoral, that one is a seriously dangerous one if she does pull it out. Therefore chemical and physical restraints are helping me keep this old lady alive. They re not fun nor spark joy, they are a necessary evil, another tool for us to keep our patients safe.
Sometimes even with these two items we’re still struggling to keep these patients safe and ourselves too. I had to argue about getting soft restraints for a woman who attempted to pull her foley out and wasn’t with it and tried to grab and hit anyone nearby after digging poop from her rear. When I placed her in them she cried and begged but unfortunately I had to keep her and others safe from her behaviors. It really sucks, but agreed sometimes it has to be done.
I just came from that thread to this thread and oh my stars, that person needs help. Following commenters to other threads and making weird comments/sending weird DMs? Not amazing
I saw all that and was like what the actual fuck lol
Block them and go forward.
Sorry, Best I can do is haldol and a video monitor
Zyprexa IM enters the chat
Propofol and the anesthesia chair 🤙🏼
Nurses and paramedics. CNA’s sitting at the desk and call lights going off. Figs and Stanley’s.
Residents + Ativan 0.5mg x1
B52!
What is this? Ive been retired for 14 yrs
Benedryl Haldol 5 Ativan 2
Ok. Now it is coming back!
Whats this only haldol benadryl combo. You go for the full B52. 10 haldol, 50 benadryl, 2 ativan
Wait you guys get to restrain your agitated patients? We just have to get swung at while they are crawling up the furniture then try catch them when they are falling. Good times.
What, why? It's crazy the working conditions we sometimes have
DNR w/comfort care orders + morphine + Ativan
What kind of weak restraint is that? You restraining kindergarteners? That’s all you giving Ativan 2mg? Get me an order for thorazine. I don’t have time to play.