ANXIETY
Severe anxiety, which comes in many forms, can be impairing to a patient and interfere with cognitive function, decision making, focus, and the ability to understand and cooperate with medical and psychological care. Anxiety can be periodic such as in “anxiety attacks” or be in a more chronic form. It is commonly part of a bigger and more complex mental illness state such as major depression, bipolar disorder, or the cognitive disorders (schizophrenia) as well as others. Whatever form it takes if it is of sufficient severity to impair a patient’s function and ability to understand and cooperate with their care it may be in the best interest of the patient to attempt to reduce their anxiety with medication on scene.
Panic is a unique and usually episodic severe symptom complex. It is often predominated by physical symptoms that often add to the frightening experience. These include such things as chest pain, shortness of breath, dizziness, tingling, and confusion. Interventions that calm the patient and encourage normal breathing may assist. The physical complaints need to be investigated as part of the work up of these patients before medical intervention.
Procedure
1. An Intranasal (IN) benzodiazepine can be an effective, safe, and expeditious intervention.
2. Prior to any medication administration a medical history and appropriate physical examination will be conducted to the extent the patient will allow.
3. Prepare MIDAZOLAM into an atomizer for administration.
4. The recommended dose is 2.5-5.0 mg. IN. This may be repeated as needed every five minutes.
5. If indicated the IM route is acceptable.
6. The patient should be advised the medication can cause a “buzz” or feelings of unreality or disorientation, sedation, and calming.
7. There are few contraindications.
a. Allergy to the medication
b. Significant intoxication with alcohol or other sedative drugs
c. Prior history of a poor reaction to similar medications (Lorazepam, Clonazepam, Diazepam)
d. Evidence of head trauma or impaired cognition due to an existing medical condition
8. The medication can cause impairment itself complicating obtaining informed consent, cooperating with treatment and transport, or completing a refusal of care. This downside must be taken into consideration prior to administering any medication. In most cases the patient is better able to make important decisions and cooperate with care due to the medication’s calming properties. The treating paramedic and team will need to make a determination of the patient’s capacity after the medication has become effective.
9. Administration of MIDAZOLAM does not necessitate transport. The overwhelming majority of patients can be left on scene in the company of a responsible adult after use of the medication. Many of these patients, relieved of intense anxiety, will wish to sleep.
Severe anxiety, which comes in many forms, can be impairing to a patient and interfere with cognitive function, decision making, focus, and the ability to understand and cooperate with medical and psychological care. Anxiety can be periodic such as in “anxiety attacks” or be in a more chronic form. It is commonly part of a bigger and more complex mental illness state such as major depression, bipolar disorder, or the cognitive disorders (schizophrenia) as well as others. Whatever form it takes if it is of sufficient severity to impair a patient’s function and ability to understand and cooperate with their care it may be in the best interest of the patient to attempt to reduce their anxiety with medication on scene.
Panic is a unique and usually episodic severe symptom complex. It is often predominated by physical symptoms that often add to the frightening experience. These include such things as chest pain, shortness of breath, dizziness, tingling, and confusion. Interventions that calm the patient and encourage normal breathing may assist. The physical complaints need to be investigated as part of the work up of these patients before medical intervention.
Procedure
1. An Intranasal (IN) benzodiazepine can be an effective, safe, and expeditious intervention.
2. Prior to any medication administration a medical history and appropriate physical examination will be conducted to the extent the patient will allow.
3. Prepare MIDAZOLAM into an atomizer for administration.
4. The recommended dose is 2.5-5.0 mg. IN. This may be repeated as needed every five minutes.
5. If indicated the IM route is acceptable.
6. The patient should be advised the medication can cause a “buzz” or feelings of unreality or disorientation, sedation, and calming.
7. There are few contraindications.
a. Allergy to the medication
b. Significant intoxication with alcohol or other sedative drugs
c. Prior history of a poor reaction to similar medications (Lorazepam, Clonazepam, Diazepam)
d. Evidence of head trauma or impaired cognition due to an existing medical condition
8. The medication can cause impairment itself complicating obtaining informed consent, cooperating with treatment and transport, or completing a refusal of care. This downside must be taken into consideration prior to administering any medication. In most cases the patient is better able to make important decisions and cooperate with care due to the medication’s calming properties. The treating paramedic and team will need to make a determination of the patient’s capacity after the medication has become effective.
9. Administration of MIDAZOLAM does not necessitate transport. The overwhelming majority of patients can be left on scene in the company of a responsible adult after use of the medication. Many of these patients, relieved of intense anxiety, will wish to sleep.