Haldol and Ativan cocktail IV

[TRAMA1RN]

Okay have been working in small ER over one year. I cannot remember How often and the maximum dose you can give of H and A. The larger ER I used to work 2 years ago that saw quite a bit of psych, used to start with 10mg Haldol and 2mg Ativan, then every so ofter till patient was calm. I had an out of control patient the other night and ther ER doc would not give more than 10 and 2, patient ended up in four point restraints and was still able to cause some minimal harm to staff and self. Any suggestions would be greatly appreciated.

[HARRYPOTERRN]

When i worked in wilmington they called it the christiana cocktail 9 haldol, 1ativan and i of cogentin im

[Penelope_Pitstop, BSN, RN]

HARRYPOTERRN said:

When i worked in wilmington they called it the christiana cocktail 9 haldol, 1ativan and i of cogentin im

On 3West? Because I never heard it when I worked on the surgical floor there...

(PS- randomly found this thread and I might just be one of the only regular posters here who knows what 3West is!)

[chevyv, BSN, RN]

Wonder if they could have tried some benedryl with that combo? We've had some luck with Zyprexa as well.

[psychlvntorn]

I work in a large free standing psych facility. In severe cases of agitation we have used as much as Haldol 10mg, Ativan 4mg, and Benadryl 50 mg IM. We have on occasion repeated this in 2 to 3 hours, but it is rarely needed. We rarely ever give any IM antipsychotics without Benadryl. I have seen patients in restraints that are still able to sit up some, bang their heads, spit and try to bite you. However I have never been in a situation where the police were called to use a stun gun etc. That is an experience I hope to never see and I am sure you felt the same.

[PsychRN98, ASN]

Haldol and Ativan IV? Never gave it that route in either the freestanding emergency psych facility I worked at for 8 years or the hospital-based psych unit and psych ER I worked at for a year. We always used IM meds, and usually they were effective. Of course there were a few exceptions over the years of those who no amount of meds would touch (pcp, etc). Usual dose though was 5 of Haldol (never gave 10 at once) with Ativan and either Cogentin or Benadryl. The freestanding emergency psych was much more liberal with the meds ordered than the hospital-based one, interestingly.

[hanasea]

Working in a psychiatric ward of university hospital for solid 1 year. Giving Ativan 2mg and Haldol 5mg mix via IV to sedate patients such as Schziphrenia, bipolar, etc. Rarely giving Ativan 4mg and Haldol 5mg. Never gave Haldol over 5mg.

[rotary]

We've given 10mg Haldol and 4mg Ativan for severe agitation. On occasion, 4mg Ativan with 150mg Zuclopenthixol Acetate.

[prison_nurse]

In the crisis correctional environment, we typically use 5mg Haldol with 25mg Vistaril IM. (We never use Ativan - benzos are not freely used in our setting). We can intervene earlier and give smaller doses, because we are seeing these patients before they get to the extremely agitated and grossly psychotic stage. If we do have to go higher, then 10mg Haldol and 50mg Vistaril IM.

Benzos can also be activating for some people. I remember in the state hospital setting giving a young lady Ativan. Wow... We never did that again! She was bouncing off the walls..

[Simply Complicated]

I work inpatient psych, occasionally float to our psych ER. We usually don't give more than 10 of haldol and 2 of ativan. If the patient is still not under control, our docs will order Zyprexa, Geodon, or Prolixin to be given. Depending on the patient, diagnosis, behavior, etc. But even this we would wait 45 minutes to an hour before administering.

[magnoliophyte]

I work in a lockdown involuntary setting, and we favor 5 haldol, 2 ativan, 50 diphenhydramine. We actually RARELY have to do this. Most people, when I tell them I work in involuntary lock-down psych imagine that we shoot everyone full of the cocktails as often as we can. Sometimes I swear that it must be everyone else's approach... we get people from ED's who have been given 3-400 mg of Thorazine on top of cocktails and it amazes me they don't show up with tardive dyskinesia.

[Roy Fokker, BSN, RN]

I've had pts. who ended up being intubated because nothing short of deep sedation+paralytics (because Haldol, Ativan, Versed, Dilaudid, Benadryl, Fentanyl AND Zyprexa did nothing!) would control their violent behavior!

cheers,

[newtinmpls, BSN, RN]

Our version of a B52 is given either orally or IM and consists of Benadryl 50, Haldol 5 and Ativan 2 (if IM, you have to give the benadryl in a separate syringe). Give it at least 10 min.

In the ED they tend to be a little quick on the draw with droperidol (can't recall if it's IM or IV).

As for the patient who was in restraints and IM'ed and wouldn't calm down - shut up and deal. For gods' sakes, a patient IN RESTRAINTS isn't going anywhere, and isn't going to do anything (unless the restraints were improperly applied which is another issue). I dislike nurses who are so into their power struggles that they can't let the patient have the last word (or scream, or insult, or whatever). Even a psychotic struggling restrained patient deserves a calm, respectful presence telling him/her what is happening, why it is happening and the conditions for changing it.

Diane