Point-Counterpoint | IV Haloperidol Should be Avoided in the Emergency Department
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Here are the counterpoints for why these authors think intravenous (IV) haloperidol (Haldol) should be avoided in the emergency department setting.
Psychiatry
Point-Counterpoint | IV Haloperidol is Safe for Emergency Department Use
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The next couple of reviews will look at different authors making their case for why intravenous (IV) haloperidol (Haldol) should or should not be used in the emergency department setting.
Source
Haloperidol May Be Safely Administered Intravenously in the Emergency Department. Annals of Emergency Medicine. 2023;81:95-96. doi: 10.1016/j.annemergmed.2022.07.004
Alcohol Withdrawal – Should We Reach for Phenobarbital?
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Hospital adoption of phenobarbital for severe alcohol withdrawal syndrome (SAWS) was associated with lower rates of invasive mechanical ventilation (IMV).
Source
Phenobarbital for Severe Alcohol Withdrawal Syndrome: A Multicenter Retrospective Cohort Study. Am J Respir Crit Care Med. 2022 Nov 1;206(9):1171-1174. doi: 10.1164/rccm.202203-0466LE.
How to Diagnose a Functional Neurological Disorder – Inconsistency and Incongruence
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Inconsistency and incongruence are two keys to diagnosing a functional neurological disorder. The video demonstration really helps sort this out.
Source
Inconsistency and incongruence: the two diagnostic pillars of functional movement disorder. Lancet. 2022 Jul 23;400(10348):328. doi: 10.1016/S0140-6736(22)01184-9.
Let’s Talk About Long COVID – What Is It?
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Patients with long COVID had a host of symptoms, poorer quality of life, and more anxiety and depression, but they did not have a specific cause identified for symptoms despite a comprehensive exam and battery of tests.
Source
A Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline Findings. Ann Intern Med. 2022 Jul;175(7):969-979. doi: 10.7326/M21-4905. Epub 2022 May 24.
Can We Use Droperidol for Pediatric Agitation?
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This systematic review suggests that droperidol is both safe and effective for treating agitation in the pediatric population.
Source
A Systematic Review of the Effectiveness and Safety of Droperidol for Pediatric Agitation in Acute Care Settings. Acad Emerg Med. 2022 May 1. doi: 10.1111/acem.14515. Online ahead of print.
Droperidol’s Reintroduction | A Risk-Benefit Analysis
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New research on droperidol shows that it is a safe and effective medication for a multitude of common ED presentations, despite an FDA black box warning for QTc prolongation in 2001.
Can Opioids in the Critically Ill Induce Delirium?
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The quick answer is yes. This has been a debate in the critical care and pain literature for quite some time, but according to this trial, we finally have our answer – receiving opioids in the ICU increases the odds of delirium in a dose-dependent fashion
Ketamine vs Midazolam-Haloperidol for Acute Agitation
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Use of intramuscular ketamine for patients with severe agitation resulted in significantly shorter time to sedation compared to a combination of intramuscular midazolam and haloperidol (5.8 vs 14.7 minutes).
IM Droperidol versus Olanzapine for the Agitated Patient – Which to Choose?
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There was no difference between IM droperidol and IM olanzapine in time to adequate sedation for the acutely agitated ED patient. Droperidol carried a slightly higher risk of extrapyramidal effects.