Lee, I respectfully agree and disagree. I agree that the DT's need to be agressivly addressed. But disagree with not using Diprovan based on current patient which is becomming more common... your etoh'er with pulmonary compromise. We now use diprovan even with the etoh'ers. especially so. We have a DT protocol with Ativan ordered to treat the HR, BP and temp. We sedate with diprovan.
Diprovan is the drug of choice because you shut if off, do your neuro exam Q shift and back down again.... can't do it the same with Ativan, mostly end up with respiratory compromise... here's the classic example... taking care of now;
Big etoh, aspirated, ARDS on oscillator, then on pressure control, AC, now cpap. (Before cpap today, we had a very narrow window of opportunity to shut off paralyzation, sedation to do neuro checks, would breathe 40-50's go into immediate resp. and metabolic alkalosis and crump). Not uncommon with ARDS. This person is now on CPAP, diprovan of 115 mcg/kg/min. last night breathing in the 40's with prn's, easily responsive, yet not able to follow commands (to slow down breathing) with full sedation!!! Only after speaking with the neuro doc and pulmonologist got the ok to add versed to control thr resp rate but had ph of 7.59 this am. Had to add versed at 5mcg to keep pt. breathing in 30's. aLL WHILE ON CPAP WITH ATIVAN AND MORPHINE.
So, don't always have time with these sick resperatory patients to let ativan wear off while their breathing 50x's per min. But we DO treat the etoh with the ativan,and you raised an excellent point!!!!!!! We just don't sedate with it. If ativan fails we even have used an ethanol drip.
FYI to konni your drinkers will require VERY high doses, it's ok, just watch for side effects like hypotension with the diprovan. We have a protocol that over 50 mcg/kg/min requires md ok, after that the pharmacy states 200 mcg/kg/min are ok. Yes anesthesia uses Diprovan in these high doses but don't let that scare you off.
Sounds like you've identified a future policy or protocol that needs to be in place with this patient population....it would make a great clinical ladder project!!!!!!!
thanks for listening to my OPINION hope it helps