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Stay tuned for an EMCrit podcast with Scott Weingart and Marc Martel, to discuss sedation, olanzapine, Levalbuterol (Xopenex)- Multum patients escaping into the ceiling.

Picture credits: opening image is from Sharma 1998 showing a telemetry strip from a patient who received IV haloperidol and subsequently developed TdP, with additional image from here. Filed Under: PULMCritI would love to see a comparison between Ziprasidone (Geodon) and Olanzapine. From my reading and experience, ziprasidone has less akathisia than haloperidol. I suspect olanzapine would be equally efficacious. Exactly how much risk of TdP that translates into is unclear (probably not much).

Maybe Marc Martel could comment on the relative efficacy of these agents for migraine. It is extremely efficacious, and my go to drug. I have looked at ziprasidone in the past for agitation (not headache).

Clinically, my biggest concern was onset of action, it was more in the 20-10 minute time range. Just too slow time to clinical effect in agitated ED patients. In our ICU (large academic MICU) there is a policy about getting Qts, either on the monitor or on an EKG, for people we order Haldol for.

I have been skeptical of this policy for a few reasons. I Levalbuterol (Xopenex)- Multum tend to rely more on benzodiazepines in agitated patients without obvious psychosis as benzodiazepines are incredibly safe in the non-intubate patient in the acute ED setting.

The most notable source of big pharma influence was a series of RCTs comparing IM olanzapine vs IM haloperidol. Several of these Betrixaban Capsules (Bevyxxa)- FDA actually written directly by employees of Eli Lilly. Some studies did seem to be tilting things in favor of olanzapine (e. However, there were additional RCTs without conflicts of interest which reached release negative emotions conclusions.

The risk of TdP from haloperidol may be overblown. Historically, haloperidol-induced TdP has occurred mostly in patients getting astronomical doses of haloperidol. Still, I think the TdP issue is clinically relevant for three reasons: 1.

Regardless of the precise risk of TdP, the FDA and most literature recommend checking EKGs in patients getting haloperidol. I agree that haloperidol by itself is extremely unlikely to cause TdP. We do have the oro-dispersable tabs.

Are you aware of any studies looking at whether Levalbuterol (Xopenex)- Multum efficacy of the dissolving tabs is comparable to the IV formulation.

I tried contacting him on twitter but no Levalbuterol (Xopenex)- Multum. I wonder if haloperidol just reduced agitation from delirium to the point that myoclonus could actually be visualized. FacebookRSSTwitterYouTube Levalbuterol (Xopenex)- Multum Stuff Have a great idea for the next podcast. Maybe you have an answer. When you're done listening to the podcast, check out these great sites. Who We Are We are the EMCrit Project, a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM.

EMCrit is a Levalbuterol (Xopenex)- Multum of Metasin LLC. This site represents our opinions only. See our full disclaimer, our privacy policy, commenting policy and here for credits and attribution. Questions Before Joining (FAQ) Join Now. Introduction Levalbuterol (Xopenex)- Multum a case An elderly woman was admitted to the ICU for COPD desalination requiring BiPAP.

Efficacy of olanzapine for acute agitation Efficacy of IM olanzapine The efficacy of IM olanzapine has been investigated more thoroughly than IV olanzapine. Efficacy of IV olanzapine Chan 2013 performed a prospective RCT of agitated emergency department patients who received titrated open-label midazolam in addition to being randomized Levalbuterol (Xopenex)- Multum receive one of three treatments: 5 mg IV olanzapine, 5 mg IV droperidol, or placebo.

Safety of olanzapine: Torsade de pointes.



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