Fun night

All started yesterday morning when we heard a convict with a dilantin overdose was being directly admitted as a 1 on 1 direct observation.  The kid was pretty out of it.  Couldn't tell us his name or any other information of a personal nature.

WGP guy wrote: I just don't understand the use of haldol acutely before procedures.  The onset is about 45 minutes.  I've seen people in the ED expect it to quickly calm and sedate a patient, but it just isn't designed to do that.  Phenytoin is also a major inducer of all the P450 enzymes, so the haldol dose would need to be at least 150% normal to achieve a therapeutic plasma level. A short-acting benzo or anesthetic is probably a better choice for acute, preprocedure sedation, but obviously not for this patient for concerns of resp depression.  Probably 20mg of ziprasidone one hour before the NG tube would have done the trick.

WGP guy wrote: usafpilot07 wrote: WGP guy wrote: I just don't understand the use of haldol acutely before procedures.  The onset is about 45 minutes.  I've seen people in the ED expect it to quickly calm and sedate a patient, but it just isn't designed to do that.  Phenytoin is also a major inducer of all the P450 enzymes, so the haldol dose would need to be at least 150% normal to achieve a therapeutic plasma level. A short-acting benzo or anesthetic is probably a better choice for acute, preprocedure sedation, but obviously not for this patient for concerns of resp depression.  Probably 20mg of ziprasidone one hour before the NG tube would have done the trick. we get it, you med school It's been like 10 years and I still can't escape it.  Ahhhhhhhh

WGP guy wrote:  Probably 20mg of ziprasidone one hour before the NG tube would have done the trick.

I had to respond to a belligerent drunk one day. He was about to go to treatment for being an alcoholic. The rehab facility told the guy's mother (he was 23 or so) to give him some alcohol through the weekend so he wouldn't go through the DTs(?) before he made it to the rehab facility. She ended up giving him a ton of whiskey, and he got drunk as Cooter Brown. I went to the house because his ex-girlfriend stole his cell phone, and I took a report even though he was thoroughly hammered and agitated. I left, but he had a seizure 15 minutes afterwards. The fire department and an ambulance showed up to treat him for his seizure. Once he woke up, he started beating on the fire crew that was trying help him. I showed up and four fire fighters were hanging on to him. I managed to get him cuffed, and he started calming down. I stood him up to walk him to the ambulance, and he went nuts again. He tried to headbutt me and then landed a few knees into my thigh (he was going for the jewels but I turned) before I managed to get him back on the ground. My sergeant arrived on scene and was around 250lbs at the time. Even with the sergeant on his back, the guy started lifting himself up. I stood on the guys head (I was only 150 at the time) and he still lifted us both up. We managed to get him contained and to the hospital (I rode in the back of the ambulance holding him down the whole time). He went nuts for what seemed like an eternity, until the staff pumped enough ativan into the guy to slow him down. That was the day I learned about the super human strength of drunken crazy people.

StormyKnight wrote: deadeye007 wrote: I had to respond to a belligerent drunk one day. He was about to go to treatment for being an alcoholic. The rehab facility told the guy's mother (he was 23 or so) to give him some alcohol through the weekend so he wouldn't go through the DTs(?) before he made it to the rehab facility. She ended up giving him a ton of whiskey, and he got drunk as Cooter Brown. I went to the house because his ex-girlfriend stole his cell phone, and I took a report even though he was thoroughly hammered and agitated. I left, but he had a seizure 15 minutes afterwards. The fire department and an ambulance showed up to treat him for his seizure. Once he woke up, he started beating on the fire crew that was trying help him. I showed up and four fire fighters were hanging on to him. I managed to get him cuffed, and he started calming down. I stood him up to walk him to the ambulance, and he went nuts again. He tried to headbutt me and then landed a few knees into my thigh (he was going for the jewels but I turned) before I managed to get him back on the ground. My sergeant arrived on scene and was around 250lbs at the time. Even with the sergeant on his back, the guy started lifting himself up. I stood on the guys head (I was only 150 at the time) and he still lifted us both up. We managed to get him contained and to the hospital (I rode in the back of the ambulance holding him down the whole time). He went nuts for what seemed like an eternity, until the staff pumped enough ativan into the guy to slow him down. That was the day I learned about the super human strength of drunken crazy people. Somebody needs to get with the idiot that advised giving alcohol.  That was patently irresponsible. So, no ECD?  They are a wonderful equalizer.  The Director of our Department is a retired Sheriff.  He felt we didn't have enough tools to do our job.  Our Taser X2s are awesome!  Full HD video and sound recording capability to cover our backs.

Have you ever had to deal with someone on PCP?  That's no joke, and the one I've seen a taser did absolutely nothing.  It took half a dozen firefighters and cops, plus 10mg of valium to control him.

StormyKnight wrote:  They are a wonderful equalizer.  The Director of our Department is a retired Sheriff.  He felt we didn't have enough tools to do our job.  Our Taser X2s are awesome!  Full HD video and sound recording capability to cover our backs.

We don't have Tasers because the chief doesn't like the negative publicity. I would disagree, but that is above my pay grade.

The worst part of the whole experience was noticing that he bled on me right next to a cut I received during the altercation. Six months of testing made me nervous, but it all turned out good in the end.

WGP guy wrote: Have you ever had to deal with someone on PCP?

impulse418 wrote:   The B also stands for Benadryl. Nothing like a little bootie juice to calm 'em down.

At first I was ready to amputate my arm to keep the zombie blood from spreading throughout my body (I was Herschel before it was cool), but a nurse sat down with me and weighed out a risk vs reward for taking the meds. I agreed to go with testing(said the meds would make me sick as heck and the transmission rate for my exposure is very minimal). I was pretty sure that the blood didn't get in the cut so I did a base line test for all the heps and HIV, then tested again after three months and another three or four months. Came back fine, but I was still nervous waiting on the second and third tests.
A few years later half of the shift had to pig pile a guy that was HIV positive and bleeding (after the pig pile). They were taking them meds like candy.
Hindsight being 20/20 I still should have opted for the meds.