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by LIZPICURN

Quick question. I have been a PICU RN for 3.5 years and travelled two years. I have seen different ways to treat different scenarios per hospital. My question is we had a child that was continuously seizing in a pentobarb coma. The RN caring for the child was treating with intermittent VERSED doses. I have always used Ativan. The versed seemed to be doing nothing. I think finally they did give Ativan in which the seizing stopped at least for the next few hours. Does anyone have an opinion on this scenario? I guess I have never used Versed to treat seizures.

[TazziRN]

Re: Versed versus Ativan??

Uhh.......Versed is an amnesiac/hypnotic.....does absolutely nothing to stop seizures.....

[MackNJacks mom]

Re: Versed versus Ativan??

I work on a pedi neuro floor, and we have never used versed to stop seizures and I wouldn't think they would. You were definately right to use ativan. When MDs at our facility write PRN orders it always says what to use it for. Like Ativan for sz lasting longer than x. Versed is never PRN at our facility, but then again I don't work in a PICU.

[Gompers]

Re: Versed versus Ativan??

Yep, in the NICU we've never used versed for seizures - only BID phenobarbital plus ativan if there is breakthrough seizing. The only time we ever use versed is when we have an older baby (corrected age >2 months) who needs either continuous sedation (versed drip) or emergency sedation without IV access (intranasal versed).

Was there an ativan AND versed order for this patient? Well, I suppose it doesn't matter - either way, she should have asked for ativan.

[LIZPICURN]

Re: Versed versus Ativan??

Thanks for the reply. I myself thought it was crazy that Versed was being utilized for seizures. The resident was sitting next to me and I nicely questioned her about the order. She said she talked to the ATTENDING and that was the treatment being utilized. I suggested Ativan several times and she just gave me a glazed look. I finally talked to the charge nurse. At this time there were interventions made. And Ativan was utilized.

[slcpicu]

Re: Versed versus Ativan??

Although versed is not typically used in the PICU to stop a sz. It is utilized in the ED and at home intranasally. I actually have taken care of pt.'s that use it as a last resort intranasally at home to help stop the sz. But overwhelmingly ativan is a first line defense also we use propofol if it is a status situation along with many others.

[Pedi-ER-RN]

Re: Versed versus Ativan??

We do use it occassionally in the ER with the Pedi's that have Sz'd at home, given Diastat X's 2, we've given ativan and they are still having sz activity. I have seen it work. It is not first line for sz as you have stated. According to Mosby, Versed is a CNS depressant and can act as an anticonvulsant as well as its other uses. We always start with Ativan, but one of the neuro's loves versed.

[serialmom12]

Re: Versed versus Ativan??

In my opinion,Versed should be totally banned by the FDA. I had such a bad reaction to it that my quality of life is the pits. I have lost about 15 years of precious memories, suffer from Bipolar disorder, PTSD and numerous other emotional & psychological problems from this drug. I was given it in an IV w/o my knowledge or consent under the pretense that it was "something to relax me."
I haven't been the same person since 10/31/91. People that knew me before say that I'm a totally different person since that incident.
First of all the stuff doesn't work. I woke up 5 times during an endoscopy, my throat is permanantly damaged now, I can't eat alot of foods that I used to be able to. They OD'd me on it, and (I'm told,) that I became violent with the Dr and stopped breathing. I woke up covered in bruises and scared to death. Everyone treated me like I was crazy, until one kindly older nurse told me that they had 4 orderlies holding me down because I was strangling the Dr doing the endoscopy! I have no recollection of this, and now I live in constant fear. Especially of the medical profession in FL. They are the pits.
I wear a medic alert bracelet an have it all over my emergency info and patient records that I'm allergic to versed and STILL they always try to force this crap on you!! They use it because it's cheap and they can make a large profit. Propfol is a MUCH better drug (though far from perfect,) but it's more money and not a moneymaker for the hospital.
If you love someone, please advise them to put that they are allergic to Versed on everything they can. It's an evil poison that does way more harm than good. They tried to force it on me for a colonscopy and I finally, very politely told the nurse "I discussed this with the Dr and I'm going to do this w/o any sedatives, if you try to pump Versed into my IV, I will rip it out of my arm and leave....do we understand each other?" and smiled sweetly. (By the way a colonoscopy is virtually a painless procedure and drugs, especially Versed is totally unnecessary for this. I watched in on the screen, and it was very interesting.)

[texas2007]

Re: Versed versus Ativan??

I've seen it used in the nicu once, as a last resort thing. We had a birth trauma kid in who started seizing about an hour after admission. Had him on the cooling blanket, max of phenobarb, max of ativan, and it didn't even touch it so they started Versed and worked it up to more than the max dose/kg but still nothing. It was a very sad story.

[meandragonbrett]

Re: Versed versus Ativan??

Originally Posted by TazziRN

Uhh.......Versed is an amnesiac/hypnotic.....does absolutely nothing to stop seizures.....

midazolam actually is used frequently to treat acute seizures.