> Whatever about the drug - the "RCT" in the Lancet was evaluated by FFAEM
> candidates last November, who were not impressed. Read it critically!
>
>
Cutting through all that bonhomie in your message, you're right Patrick. I
remember now,there were a few tiny flaws in the methodology. Wasn't it the
paper where the method of randomisation was described as "shuffling" ? This
is plainly inadequate. Was it air shuffling or table? Who shuffled and what
sleeves were they wearing?
Buccal midazolam may yet turn out to be a useful pre-hospital drug for
status epi, and proper evaluation will surely come. The first publication on
a new treatment (? I think it's the first, Patrick) is often flawed, but
such papers are interesting in making one think about alternatives. I guess
this is why it was published.
Steve Meek
> ----------
> From: Patrick K. Plunkett[SMTP:[log in to unmask]]
> Sent: 10 January 2000 19:26
> To: [log in to unmask]
> Subject: RE: Fits: best acute treatment?
>
> 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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