Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

More Happy Excited Delirium Commentary

First, CCC (Captain Chair Confessions) is looking for protocols. Go give him a link to your protocols. This looks as if it will be a very useful way for us to show their medical directors how things can be better.

Fishing for protocols.

CCC responded to the videos in Happy Excited Delirium Commentary with –

That dude was tripping hard.

A little too hard.


Image credit.

If that’s a bad trip, I wonder how good the good trip would be?

How good depends on your preferences. Just as with a preference for beer, or wine, or liquor, or cigarettes, or marijuana, or anything else – tastes vary. However, there does not appear to be any valid excuse for reality TV. 😉


Image credit.

This doesn’t look like a good trip to me, but not everyone has the same idea of a good time. Maybe this is what he thought he was looking for, but when his mind got there, he didn’t like it.

All I carry to sedate is 4mg Versed and 20mg Valium. I don’t think that would be enough for homeboy.

For the first patient, that amount of midazolam (Versed) and diazepam (Valium) should be enough. He was cooperating as much as he could, but for the second patient (who may also have been cooperating as much as he could) more would probably have been needed. If for no other reason that the patient appears to weigh a lot more. Drugs are supposed to be give according to body weight.

Remember that (with medical command permission) you can also use opioids to sedate, so morphine and fentanyl can be given in addition to the tiny amount of benzodiazepines that you carry. Diphenhydramine (Benadryl) is another drug that can be used to sedate. One of the benefits of diphenhydramine is that it will counter the extrapyramidal symptoms that are often produced by haloperidol (Haldol) if any haloperidol is on board or any of the other drugs that may cause extrapyramidal symptoms (haloperidol is just the drug that most commonly blamed for this).

I know what some people are thinking – How can 4 mg midazolam and 20 mg diazepam be a tiny dose?

I am not a mind reader, but I do receive this kind of response to so many things that I do, that I am not surprised when some medically naive people state something similar to this.

Allow me to provide an example –

I was treating a teenager who was less than 50 kg. This patient was very agitated/excited and her inability to put two syllables together in a coherent way strongly suggested delirium. After 10 mg midazolam, she was still very tachycardic and tachypneic, but there was no change in her coherence. Blood sugar was normal.

This may be a little less than 4mg Versed and 20mg Valium, but not much.

She was a small patient. 50 kg is 110 pounds and she weighed less than that.

After the midazolam doses (5 mg and 5 mg), she was maintaining a sat of 100% on room air. Her respiratory rate was still twice what it should have been, even though she had respiratory depression compared with her initial respiratory rate. With respiratory depression, she was still breathing too fast.

She was breathing too fast and the patient had respiratory depression compared to what her initial respiratory rate was.

Maybe she needed more sedation.

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