You’re Staying Here
Posted by WhiteCoat on September 27, 2008
If you go to a hospital with the “alcohol shakes” and you have depleted the hospital’s reserve of Ativan by receiving 66 mg of intravenous Ativan to improve - not alleviate, only improve – your symptoms over the previous 24 hours, there is no way in hell we are going to let your jittery, wobbly-gaited, cantankerous self sign out against medical advice so you can go see your attorney for an appointment … at 7:00 PM … on a Friday night … when you don’t know your attorney’s name … or his address … and you plan on driving there.
For someone on the verge of DTs, it was a nice try, though.
Ativan pills come in 0.5, 1, and 2 mg and are usually taken a few times a day. Intravenous Ativan comes in 2 mg vials, so the pharmacists were creating a little pyramid with all the empty vials that were piling up.
Wish I got a picture of that. Nurse K could have used it for a new header on her blog.
maplelf71 said
Seems like a drip would be more prudent and less time consuming.
We used to get the really bad ETOHer’s in my ICU. I’ve seen Ativan drips as high as 10mg/hr (with boluses prn). But then, on the really tough ones, we’d use Versed gtts. That will get the job done FAST.
The best part of taking care of these patient’s is that you never get a chance to miss them. The keep coming back, and coming back…. until eventually they resemble Sponge Bob Crappy Pants and then they kick off despite the lactulose…..
Gotta love those lactulose runs …
ERP said
Wow. 66mg. The most I have seen or given “therapeutically” was 30mg.
Steve said
And I bet somebody in your hospital was worried about “detaining” the person “against” their will!!!!
SSSHHHEEEEEAAAT when someone is THAT stooooppiidd then they obviously are not capable and therefore DO need protection!!!!
Steve
nikkik said
cripes! how much ativan can you give?
Paul said
Valium q1h until asleep. Then let self-taper. no dt’s or extended obs needed.
cynic said
Been there once, gave up after 30mg + . Found it easier to put him on the vent. rocuronium is a blessing.
The Happy Hospitalist said
I’ve given over 300 mg of Ativan in a 24 hour period. By the way, in my state, you can’t hold a person in the hospital medical unit against their will, even if they are not with it. Since they came in voluntarily, they can leave voluntarily, unless they are deemed incompetent to make medical decisions. I think it takes a legal ruling by a judge. But that won’t happen immediately. I have been told that if a patient wants to leave against medical advice and I don’t believe they are of sound mind to make that decision, I have to let them walk out the doors of the hospital. At this point, we call the police department and have them pick the patient up as being a danger to themselves and others. They can put an emergency protective hold and force the patient into the hospital, against their will, for 48 hours, I believe, until a psychiatrist or judge deems them incompetent.
So yes, you can’t hold a patient against their will in my parts, even if they were running around naked and singing country music
If they get 300 mg of Ativan and are still vertical, they get the WhiteCoat bugeye seal of approval. I was shocked to see a patient still breathing after getting 66mg.
TEX said
Heck, depending on the patient’s admitting diagnosis, say MI, or pneumonia, the docs here just order up booze with meals and at HS. We serve Bud in this here hospital!
We did have one guy once who was an ETOHer, but didn’t tell us. Had open-heart and sure enough, 3 days post-op went postal.
He used walker that was in his room and knocked off the sprinkler head on the ceiling of his bathroom (the kind for fires).
Flooded the tele unit, it was closed for almost a week.
Nurse K said
Pyramid of ativan vials? Oh, if there was only time travel and you could go back and take a photo of that for me…
Steve said
Usually when I’m singing country western and naked…I’m in the shower…
Steve
Aaron said
66mg depleted your hospital’s stock? Wow… We have ~600mg in 2mg vials in our pharmacy at any given time, and another ~6000mg in 20mg/10mL vials for drips.
Although, yeah, we like it when y’all use valium. Lot easier to mix. The stoppers in the lorazepam are quite easy to core, and it’s a pain to filter that stuff ’cause it’s so thick.
If you just emptied your ER Pyxis, talk to the pharmacy about getting some more put it. Always simple enough, and we like making y’all happy. Cuts down on the phone calls.
That was the report we got from the pharmacy – maybe there was a run on anxious patients that day. Good to know about the Valium. Only problem is that the half-life for Ativan is 10-20 hours and the half life for Valium’s active metabolite can be up to 200 hours. If you dose too much, the patient’s going to be there for a loooong time.
NateRN said
If you have to give 20mg IV Ativan to one patient, somebody is seriously batshit. 14 in 4h is my (admittedly short-lived MST) record. (And everybody else’s pts didn’t get a whole lot of attention that night. Hope you don’t mind.)
If you let them leave the hospital, and they get run-over, or collapse and code, you will lose any lawsuit that aims to show that you let them discharge AMA unsafely. And rightly so. If the ETOH intox doesn’t invalidate the ability to make decisions about their own health, the 20mg of Ativan does. Would you let an ED cardioversion drive himself home? If he insisted? We’ve got security for a reason.
I’ve never seen anything like Steve’s saying– where overwrought concerns about patient autonomy have led to safety issues. I have, however, seen situations where overwrought concerns about patient safety have led to autonomy issues.
And if 66mg represents one pt’s dose: woah. But if 66 mg represents one hospital’s supply: serious problem.