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  • Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients

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    Author(s)
    Spain, David
    Crilly, Julia
    Whyte, Ian
    Jenner, Linda
    Carr, Vaughan
    Baker, Amanda
    Griffith University Author(s)
    Crilly, Julia
    Year published
    2008
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    Abstract
    Objectives: To trial high-dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant-induced behavioural disorders. End-points were effectiveness and safety. Methods: A prospective pilot study was undertaken with a convenience sample of adult, uncooperative patients with suspected psychostimulant-induced severe behavioural disorders. The protocol was midazolam in 10 mg increments, i.m. or i.v., at 10 min intervals, up to four doses and titrated to an end-point of rousable drowsiness. Results: Sixty-two patients were enrolled. Two-thirds of the patients required only one dose of ...
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    Objectives: To trial high-dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant-induced behavioural disorders. End-points were effectiveness and safety. Methods: A prospective pilot study was undertaken with a convenience sample of adult, uncooperative patients with suspected psychostimulant-induced severe behavioural disorders. The protocol was midazolam in 10 mg increments, i.m. or i.v., at 10 min intervals, up to four doses and titrated to an end-point of rousable drowsiness. Results: Sixty-two patients were enrolled. Two-thirds of the patients required only one dose of midazolam; 88% of the sample were sedated with two doses. Six and a half per cent of patients were not sedated after four doses. A Glasgow Coma Score of eight or less was prolonged in eight patients. Airway problems requiring an adjunct were present in four patients. Recent psychostimulant use was present in only 55% after full assessment. Conclusions: High-dose midazolam protocols cannot be supported as universally safe. High-dose protocols for severe behavioural disturbance are not more effective, with failures occurring even after repeated dosing.
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    Journal Title
    Emergency Medicine Australasia
    Volume
    20
    Publisher URI
    http://www3.interscience.wiley.com/cgi-bin/home
    DOI
    https://doi.org/10.1111/j.1742-6723.2008.01066.x
    Copyright Statement
    © 2008 Wiley-Blackwell Publishing. This is the author-manuscript version of this paper. Reproduced in accordance with the copyright policy of the publisher. The definitive version is available at www.interscience.wiley.com
    Subject
    Clinical sciences
    Publication URI
    http://hdl.handle.net/10072/26225
    Collection
    • Journal articles

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