Which medications in the drug class Sedatives are used in the treatment of Delirium, Dementia, and Amnesia in Emergency Medicine?

Updated: Sep 19, 2018
  • Author: Richard D Shin, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

Sedatives

These agents are used to calm acute agitation, to control the behavior of combative patients, and to facilitate procedures.

Lorazepam (Ativan)

Commonly used Benzodiazepine in ED. Safe for a wide variety of acute behavioral disturbances. Can be given PO/SL (for rapid effect in panic attack)/IV/IM and can be mixed in syringe with neuroleptic agent. Sedative hypnotic with short onset of effects and relatively long duration of action. By increasing action of GABA, a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. When patient needs to be sedated for longer than 24-h period, this medication is excellent. Has longer CNS effect than diazepam and is preferred for seizure control. Easily titrated for acute withdrawal syndromes (eg, alcohol, benzodiazepines, barbiturates) and status seizures when given IV (10 mg or more may be needed in status epilepticus). Two mg of lorazepam approximately equivalent to 5 mg of diazepam. Preferred over neuroleptics for treating toxic effects of hallucinogens, cocaine, stimulants, or PCP.

Midazolam

Benzodiazepine with rapid onset of action, effective for acute agitation. Excellent choice to calm a combative/agitated patient with rapid onset and relatively short duration of action.

Onset of action: IM: Sedation: Children: Within 5 minutes; Adults: ~15 minutes; IV: 3 to 5 minutes

A prospective observational study demonstrated intramuscular midazolam achieved more effective sedation in agitated ED patients at 15 minutes than haloperidol, ziprasidone, and perhaps olanzapine.


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