runswithneedles Posted January 28, 2012 Posted January 28, 2012 Mike; The way this usually works, is you tell us what you think so we can lead your thinking path the right way through the forest. A Q&A session will warrent you nothing. Let me ask: What are potential side effects, both good & bad, of giving low dose benzo's to an anaphylaxis patient? perhaps I shouldve started another post at that time
croaker260 Posted January 28, 2012 Posted January 28, 2012 I strongly disagree that we should be giving this patient any benzos, hang on, let me go scoff down my morning clonnies and we'll continue .... Many patients present with anxiety/hyperventilation/ some might even have carpopedal spasm or other symptoms; are we going to give them all midazolam? It is worth mentioning some patients receiving end-of-life care are prescribed midazolam or another benzo for administration in the event of severe distress or deterioration but that's different so you can't extrapolate one into the other. Kiwi, OK, first do we even want to know what the heck morning clonnies are???? Now, I think there is a bit of misconception, not all of my anxiety patients get a benzo, and those who do get valium, or ativan (when we carried it), not versed. And to be clear, the ones who get a benzo are those whose anxiety component is REFRACTORY to other more routine interventions AND where their anxiety is compromising care, assessment, or safety. They (at least in my mind) must meet both criteria. Let me ask: What are potential side effects, both good & bad, of giving low dose benzo's to an anaphylaxis patient? Well, in this case I think we all can agree that this probably was not an anaphylaxis patient, though we will never know for sure. Lets assume for arguments sake it was though.... I think that in a true anaphylaxis patient, with actual SEVERE presentation, the clinical effects of the drug would be a minor concern compared to the delay caused pursuing an anxiousness path of treatment or care, regardless weather that care involved a benzo or not. Which returns us to the my original post a while back, the important lesson here is the importance of a good history (Good Data), followed by good assessment (More good data), combined to make a identifying the problem correctly (data analysis) followed by a good decision which would lead to an appropriate action. The problem is the history that he obtained was tainted, poorly acquired, and incomplete. HIs objective assessment was better, but he ignored most of what it was telling him. This tainted his analysis of the situation and thus his actions.
Kiwiology Posted January 28, 2012 Posted January 28, 2012 first do we even want to know what the heck morning clonnies are???? Clonazepam; I was taking the piss bro Now, I think there is a bit of misconception, not all of my anxiety patients get a benzo, and those who do get valium, or ativan (when we carried it), not versed. And to be clear, the ones who get a benzo are those whose anxiety component is REFRACTORY to other more routine interventions AND where their anxiety is compromising care, assessment, or safety. They (at least in my mind) must meet both criteria. Depends, if they are agitated to the point of being combative or a danger to the crew AND they are incompetent to make decisions so need some midaz to settle them down so they can be transported it's best to have the coppers nick round and give you a hand. Now, if they are competent it doesn't matter how freaked out they get, if they don't want to be seen, assessed or treated then fine, pack up and back to watching telly. This patient doesn't really fit into either category to be honest.
croaker260 Posted January 29, 2012 Posted January 29, 2012 (edited) Kiwi, 1- DO you guys just carry Versed over there, or do you carry other benzos too? Just wondering. As said before I can think of several different benzo's better suited for anxiety.. 2- Obviously ..as some one previously said, we are both seeing different patients based off of a rather poor description. As a side note, it still amazes me how we can be talking about the same drugs, interventions, and medicine, and allegedly speak the same language...but our vernacular is so completely different. Can you imagine if we were talking in person and our accents and pronunciation was a factor too? Edited January 29, 2012 by croaker260
Kiwiology Posted January 29, 2012 Posted January 29, 2012 1- DO you guys just carry Versed over there, or do you carry other benzos too? What in the bloody hell is this versed nonsense .... we carry midazolam and only midazolam Just wondering. As said before I can think of several different benzo's better suited for anxiety.. Cool, give them to me As a side note, it still amazes me how we can be talking about the same drugs, interventions, and medicine, and allegedly speak the same language...but our vernacular is so completely different. Can you imagine if we were talking in person and our accents and pronunciation was a factor too? LOL funny
Maine-iac Posted January 31, 2012 Posted January 31, 2012 She could have thrown a small PE. Might explain clear lung sounds, high RR, no swelling, and anxiety. My preceptor told me a story once about going to a restaurant for a super panicked women in the bathroom. They tried to calm her down thinking it was just anxiety then BAM drops dead. Autopsy revealed massive PE. On a side note I would have been really interested to see her EKG.
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