David Spain, MB BS, FRACGP, FACEM, Deputy Director of Emergency Medicine; Julia Crilly, RN, PhD, Nurse Researcher; Ian Whyte, MB BS(Hons), FRACP, FRCP(Edin); Linda Jenner, MAppSci(Research), Project Officer; Vaughan Carr, MD, FRCPC, FRANCP, Director; Amanda Baker, BA(Hons), MPsychol, PhD, NHMRC Senior Research Fellow.
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Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients
Article first published online: 28 MAR 2008
DOI: 10.1111/j.1742-6723.2008.01066.x
© 2008 The Authors
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How to Cite
Spain, D., Crilly, J., Whyte, I., Jenner, L., Carr, V. and Baker, A. (2008), Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients. Emergency Medicine Australasia, 20: 112–120. doi: 10.1111/j.1742-6723.2008.01066.x
Publication History
- Issue published online: 28 MAR 2008
- Article first published online: 28 MAR 2008
- Accepted 11 February 2008
- Abstract
- Article
- References
- Cited By
Keywords:
- emergency;
- midazolam;
- psychostimulant
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 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.