Saturday, March 10, 2012

Perfect Example of Misuse of Versed/Dormicum

Dr. Kevin's blog has this little jewel from his 3/8/12 blog. Extubating the overzealously intubated patient Even the good Doctor is angry about this. It should be "Extubating the overzealously DRUGGED patient."


  1. I'm curious as to how the paramedic was supposed to ascertain baseline health background from an unconscious person? A "blown" pupil is indicative of a closed head injury and any patient with this symptom who is unconscious should be intubated.

  2. John I re-read the article and there is not enough information to support your hypothesis. The old lady fell and hit her head. At no point does it say she was unconscious. Extrapolating from the information that is there, this lady was conscious enough to vigorously object to being intubated. The fact that the EMT feels he was justified in not only physically fighting with this woman in order to intubate, but jamming her with 30mg of Versed is monumentally stupid, in my opinion. If she had a closed head injury that was severe enough to render her unconscious, she wouldn't be fighting. Do you think that all this "fighting" could raise her bp and cause additional trauma? Perhaps cause her to strike her head again? What if she also suffered a neck injury in the fall? Is Versed an acceptable drug to use on this type of patient injury? Especially in this amount? I'll see if I can find any articles where the prefered mode of action for a SUSPECTED closed head injury in a conscious adult, is intubation especially requiring 30mg of Versed to gain compliance.

    So now we move on to the 'blown pupil.' Yes blown pupils are ONE OF THE CRITERIA used to assess the damage, but not the only one. I have known many people who have injured their eye, my mother being one. In every case there has been some way of figuring out that the eye had sustained damage. Scar tissue, cloudy cornea, keyhole iris, the list goes on. OBVIOUSLY this EMT leapt to an erroneous conclusion and fought this poor woman to a standstill, to where she actually WAS unconscious. This would certainly contribute to further misdiagnosis on the part of the real doctors. With that much Versed on board she would absolutely present with symptoms that weren't caused by the injury, but rather were created by Versed.

  3. John I looked up "closed head injury Versed" and the very first 2 that I found are here;
    In this one it clearly states that the patient must be UNconscious with a GSC of less than nine in order that Versed OR ENTOMIDATE be used. Clearly this person in the article was NOT a 3, but could have been 9. Not enough information. Obviously she was also CONSCIOUS. (be careful to use the same definition of 'conscious' with this lady as you use to describe 'conscious' when the patient is whacked out on Versed.) She was awake, moving, fighting etc. therefore was conscious. This IS according to the medical profession where 'conscious sedation' is used. The article linked in this comment also says that a MAXIMUM DOSE OF 10mg should be adhered to. I didn't write it. If I had I would be eliminating the Versed completely.

    The next one is here;
    In this link it clearly states in the "contraindications" area that HEAD INJURIES are one of these contraindications.

  4. Sorry GCS, not GSC! Should have proof read better!