DilatedPupilsmYou walk into a room where a patient is screaming and thrashing about in his/her gurney from some stimulant abuse. PCP, cocaine, methamphetamine… or all of the above.

When the number of people (police officers, security guards, nurses) is greater than the patient’s pupil size, you KNOW that you’ll need some chemical sedation.

What intramuscular sedation regimen do you use?

Regimens for chemical restraint vary by institution. Before droperidol was black-boxed by the FDA for allegedly causing QTc prolongation arrhythmias, it was widely used. I called it “vitamin D”. What a wonderful single-agent medication. It’s really debatable whether the black-box label was justified.

  • HAC: Haldol 5 mg, Ativan 2 mg, Cogentin 1 mg IM all in 1 syringe
  • Midazolam (versed): 5 mg IM single agent – This is a very short acting benzodiazepine which is more consistently absorbed intramuscularly than lorazepam (ativan).
  • B52: Haldol 5 mg, Ativan 2 mg, Benedryl 50 mg IM
  • Haldol: 5 mg IM single agent

I prefer either HAC or versed alone (if I need something short-acting and don’t think I’ll need the antipsychotic effects of haldol).

Injection

What regimen do you use?
Michelle Lin, MD

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD