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ACAD-AE-MED  January 2000

ACAD-AE-MED January 2000

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Subject:

RE: Fits: best acute treatment?

From:

"Patrick K. Plunkett" <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Mon, 10 Jan 2000 19:26:39 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (107 lines)

Whatever about the drug - the "RCT" in the Lancet was evaluated by FFAEM
candidates last November, who were not impressed.  Read it critically!




At 14:28 10/01/2000 -0000, you wrote:
>> IV diazemuls for status ep?
>> Trend towards iv lorazepam.
>> Why?
>> I have misgivings about this trend, which has been led by neurologists I
>> believe. Often in the ED we want the patient to wake up so we can assess
>> them, and blanket use of lorazepam will prevent this, increasing
>> admissions and CT scanning unneccessarily. Clearly for true status,
>> sedation for a long period is acceptable but I fear lorazepam  will be
>> used in everyone who is fitting on arrival.
>> Diazepam followed by phenytoin is as effective as lorazepam and less
>> sedating I believe.
>> Side effects and time to onset were similar for diazepam and lorazepam in
>> a double blind study of 78 patients. I seriously doubt whether lorazepam
>> is less of a respiratory depressant than diazepam, and am unaware of any
>> evidence to the contrary.
>> 
>> Longer action?
>> Yes, lasts 6-24 hours depending which study you read
>> 
>> My practice is to give prolonged fitters diazepam until I know whether I
>> am happy to give a longer acting drug.
>> 
>> Pre-hospital use?
>> Lorazepam does indeed need to be refridgerated. Buccal midazolam may be a
>> better pre-hospital alternative, especially in children: RCT in Lancet
>> last year. 
>> 
>> I would love to hear from anyone involved in the APLS working party who
>> can clarify the reasons behind the change to lorazepam as I have to teach
>> this line in a few weeks
>> 
>> Steve Meek
>> ----------
>> From: 	Gautam[SMTP:[log in to unmask]]
>> Sent: 	08 January 2000 11:17
>> To: 	[log in to unmask]
>> Subject: 	Fits: best acute treatment?
>> 
>> 
>> Dr G Ray
>> Staff Grade
>> A&E
>> Sussex
>> Reply to [log in to unmask]
>> 
>> 
>> 
>> 
>> ----------
>> From: 	A S Lockey[SMTP:[log in to unmask]]
>> Sent: 	08 January 2000 20:53
>> To: 	Acad-Ae-Med
>> Subject: 	RE: Fits: best acute treatment?
>> 
>> The main reason for lorazepam is that is does not depress respiration to
>> the
>> same extent as diazepam/diazemuls. It is now the 1st line drug of choice
>> in
>> kids with no vascular access (rectal diazemuls if no vascular access)
>> according to the guidelines from the RCPCH conference in York (1999),
>> which
>> have been adopted by APLS. I use it as 1st line in A&E now for adults as
>> well (although most fitters have already had pre-hospital diazemuls by
>> Paramedics so technically it is probably still 2nd line). Having seen
>> someone recently who had 15 mg Diazemuls pre-hospital who was virtually in
>> respiratory arrest but no longer fitting (?!!), it would probably be wise
>> to
>> think about lorazepam pre-hospital.
>> 
>> Is there any region where lorazepam is used pre-hospital? I haven't
>> trawled
>> the literature I'm afraid (just got in from a nightmare shift and footy +
>> gin & tonic is more tempting).
>> 
>> Andy
>> 
>> 
>> -----Original Message-----
>> From: [log in to unmask]
>> [mailto:[log in to unmask]]On Behalf Of Gautam
>> Sent: 08 January 2000 11:17
>> To: [log in to unmask]
>> Subject: Fits: best acute treatment?
>> 
>> IV diazemuls for status ep?
>> Trend towards iv lorazepam.
>> Why?
>> Longer action?
>> 
>> 
>> Dr G Ray
>> Staff Grade
>> A&E
>> Sussex
>> Reply to [log in to unmask]
>> 
>


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