Protocol for Trauma pt's w/ addiction or mental illness

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    What effective Protocol do you use for Trauma patients that have drug addictions or mental illness? We have trouble when it comes time to
    wean or extubate from the vent.on these patients. Any resources or seminars out there? We already use Diprivan,MS,Ativan,or Versed to keep them down during the initial phase.
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  4. 8 Comments so far...

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    Have you tried haloperidol IV 2 to 5 mgs or there abouts. Of course the true secrete in weaning is when the pt. is ready the'll wean.
    good luck.
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    We use Haldol some, but it seems the problem is that to control the behavior of the pt. our drugs keep them "too down" for proper weening of the vent.It seems that we are lacking in some kind of effective psych. drug.Any ideas?
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    Hi,
    A patient who is terribly agitated is probably not ready to wean anyway - they won't protect their airway and won't cooperate with physio etc. We have fairly successfully used propofol to keep folks "down" while they are withdrawing. There is a new antipsychotic... zuclosomething (sorry, the name escapes me)that works fairly well with some people. We've has some success with Haldol 10mg iv q1h until settles or until 80 mg dose given. I know, it sounds like a lot, but sometimes works.
    Sedation and analgesia are very unique to the person that you are using them on, I have never seen a protocal that works for every patient.
    Have a great day, and yes, I have spent my share of time sitting on patient's chest while they are in DT's
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    ok... what about diparidol(sp?)diphenidol. I've seen psych. use it on a couple of patients.or just benadryl. cloindine has also been used to treat withdrawls in the past also I believe. If they are actively withdrawing then you will probably still need to treat with librium. or a combination,....a little benadryl , with a little ms, with a little of this and that. how are you weaning. T.piece, c-pap, or positive support ventilation? just going down on the cmv? that can make a bib difference too. again good luck
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    Thanks for the input, I think the psych. drugs are what we are missing. These patient's have gone through withdrawl and act psychotic. Some do have closed head injuries and if they "act" ok, would be ready to extubate(and stay extubated).Anyone else have psych. drugs to recommend in the critical care setting?
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    Droperidol- LOVE that drug. (For the patients, of course!) Low dose (.625 to 1 mg) = antiemetic. Higher dose (up to 5 or 10 in severe cases, I think) for the psychotic. Wide safety margin- does dump the BP a bit but is that the drug or the reduced agitation?
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    We use an Ativan/Haldol protocol, that usually works. A large number of our patient have drug or etoh abuse hx.
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    Just about all of our trauma pts have some sort of addiction. we generally stick to the benzos like ativan and wean them slowly. We can usually get them extubated and sent out to the step-down unit where they go into full blown DT's. We also use a lot of Haldol. Any of that class of psych drugs work great and decrease the need for Benzos. Haldol is a great drug...you just need to get that base line EKG first. My personal favorite is Vitamin A!


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