Ativan...ETOH History...7mg IV last night? Too much?

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Guys, It's been bugging me...last night in the ICU...I had a guy who was weaned off the ventilator on the 5th of August...he had awful Alcohol withdrawal and DTs the previous 2 weeks which made him be on an Ativan GTT...so last night he was on Alcohol withdrawal protocol...this guy was climbing out of the bed yelling, VSS, and I ended up giving the guy 2 mg IV Ativan...one hour later 3mg, 2 hours later 2 mg of Ativan so a total of 7...he was breathing fine but definitely zonked in the AM and the dayshift nurse was like, "Whoa, 7 mg of Ativan IV, Geez he's gonna be back on the vent because he might get pneumonia because he can't effectively cough!" I was like, "you should have been there last night and I felt he needed it..."...Is this too much in your honest opinion...to me, I asked several nurses in the ICU if this was too much and they said, "absolutely not due to his history of DTs the last couple of weeks and his being on an Ativan GTT a few days earlier in his hospitalization...

Any input would be great...Thanks:wink2:

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nah...

considering he had been on an ativan gtt for detox, he likely built a tolerance.

compound that with his agitation, his threshhold was even higher.

think of it this way:

those few hrs that he was yelling, those lungs of his were being expanded and was working those secretions...

decreasing his risk for pneumonia.:)

but since the acuity of his detox s/b over, it's time to consider meds for the long term, including one that addresses probable, forthcoming agitation- if he stays off the booze.

you're fine.

he's fine.

it's all good.

leslie

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Specializes in CCRN, ATCN, ABLS.

Definitely not too much.

However, Valium IV (Diazepam) is a better benzo against DT because it appears to work just as well and it is easier to get people off of it once they are done with ETOH. IMHO

wayunderpaid

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.

No I'm sure it wasn't too much,with his ETOH tolerance I'm sure he has a high CNS depressant tolerance,in fact if someone withdrawing has insufficient sedation on board he will have seizures. I'm sure your second guessing day shift nurse will probably tell you that she had to give beaucoup ativan,librium,haldol etc to keep him from hanging from the curtains after he slept an hour or two.:sasq:

You were there,it's not the miligram number that's relevant,it's his history and his reaction to the medicine that you monitored. She wasn't there. I know that you're probably newer and she's more experienced or something but hold your ground you did fine.:yeah:

I hate when the next shift second guess what went on before they got there. Ack!!:banghead:

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Nowhere near too much. That nurse was either playing with you or doesnt know what he/she is talking about. The ones who dont have a clue sometimes are the ones who criticize the most....way

Now if they are on an Ativan drip or requiring large doses over a 24-48 period then you need to be careful, not really in overdosing them (because benzos, despite their stigma are relatively safe) but due to the propylene glycol content.

But no 7 mg Ativan over a 3 hour period for someone in withdrawal is nowhere near too much.

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Yep...thanks for the replies...love the input

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Specializes in Med surg, Critical Care, LTC.

No, not too much ativan, however, if he's been in the hospital 2 weeks, he no longer is going through DT's - did you get a reason why he was so agitated?

I'm NOT saying this was the case, but I hate to see pt medicated for the nurses convenience. We all know this is done at times.

I would be trying to talk to this man and reason with him, THEN if his behavior escalated - for his safety and the safety of others, I would give him the ativan. That is a chemical restraint, does your hospital have a restraint policy? Did you fill out a restraint form? Just curious.

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Specializes in Utilization Management.
No, not too much ativan, however, if he's been in the hospital 2 weeks, he no longer is going through DT's - did you get a reason why he was so agitated?

I'm NOT saying this was the case, but I hate to see pt medicated for the nurses convenience. We all know this is done at times.

I would be trying to talk to this man and reason with him, THEN if his behavior escalated - for his safety and the safety of others, I would give him the ativan. That is a chemical restraint, does your hospital have a restraint policy? Did you fill out a restraint form? Just curious.

Ativan is not a chemical restraint as used in the ETOH'er in withdrawal; it is one of a few drugs that are accepted treatments for withdrawal. Therefore, we do not have to fill out restraint forms. We do have to complete the hospital's CIWA scale and follow the protocol for withdrawal.

I would also have to agree that even though he probably was not in DT's, he'd developed a tolerance.

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Specializes in Med surg, Critical Care, LTC.

Angioplasty: Certainly I see your point, the point I was attempting to make was that after that length of time, DT's and therefore physical addiction was over and done with, how can you say ativan wasn't used in this case as a chemical restraint? He was acting out, so he was given enough of the med to knock him down - is this not the way it happened?

My understanding of a chemical restraint is that if it is given to a patent for behaviorial purposes = chemical restraint. Same med given for a patients anxiety to go though an MRI = treatment - so no restraint.

MHO :twocents:

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Specializes in Utilization Management.
Angioplasty: Certainly I see your point, the point I was attempting to make was that after that length of time, DT's and therefore physical addiction was over and done with, how can you say ativan wasn't used in this case as a chemical restraint? He was acting out, so he was given enough of the med to knock him down - is this not the way it happened?

My understanding of a chemical restraint is that if it is given to a patent for behaviorial purposes = chemical restraint. Same med given for a patients anxiety to go though an MRI = treatment - so no restraint.

MHO :twocents:

I didn't see it as a chemical restraint because the med was not given for the convenience of the staff; it was given for the safety and comfort of the patient.

I guess it's one of those nursing judgment decisions (ie, I guess we had to be there).

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Specializes in Post Anesthesia.

Alcoholic patients have a tremendous tollerance for benzos. I'm sure the added work load of being NUTS wasn't helping his oxygenation. I've seen many more patients get intubated from getting too little sedation to manage thier withdrawl than from getting too much. Was he breathing?=Yes- then you didn't give too much. Screaming in DTs not an effective goal for airway management.

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Specializes in Med surg, Critical Care, LTC.

Except, he had been in the hospital 2 weeks, the DT's were long over, he was no longer addicted to ETOH!

I don't necessarily believe the nurses gave him the ativan for their convenience, but to help calm an agitated and out of control patient, which is why I believe the ativan was a chemical restraint.

When we have patients screaming, jumping up and down, raising a ruckus, if they cannot be reasoned with, they are usually giving a chemical restraint. Restraints can be used to keep the patient safe from themselves or to keep others safe from the patient.

Again, if he was in the hospital 2 weeks, he was long past the DT stage.

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