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Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
This is a major and important topic that cannot be dealt with thoroughly within this chapter [21]. The following medicines have all been shown to be effective in treating children with acute seizures: rectal diazepam, intravenous lorazepam and buccal midazolam. For children with intravenous access, lorazepam 100 microg/kg should be given intravenously; for those with no immediate intravenous access, the drug of first choice could be either rectal diazepam (500 microg/kg) or buccal midazolam (500 microg/kg). Lorazepam is considered to be more effective than diazepam and is associated with less respiratory depression [21–23]. Midazolam, administered by either the buccal or nasal route, has been shown to be effective in small prospective studies. Paraldehyde is a cheap and effective anticonvulsant for the child with an acute seizure and is best administered rectally. It can be administered intramuscularly, but there is a risk of sterile abscess formation.
Career Reflections
Published in Peter Tate, Francesca Frame, Bedside Matters, 2020
By the time Ben arrived, Harold was getting even madder; he told me later that he was trapped in a living nightmare, genuinely dreaming, half-knowing it was dream but the demons were so real, and the irrationality was totally logical in a dreamscape world. He needed sedating, restraining and hospitalising. In those days I used paraldehyde by intramuscular injection. I had used it in similar circumstances while a ship's doctor. It is horrible stuff, must be used with a glass syringe as it dissolves plastic, and is a very painful injection with a high risk of causing abscess. But it is safe in the sense that it does not cause respiratory depression, can if necessary, as it was here, be injected straight through a tough pair of trousers, and is the most effective sedating agent I have ever used. Of course, no one ever uses it now. Ben agreed with the strategy and sat in his car while I got on with it; that is the hierarchy as it was. Although a big man, I was a bit nervous at that time that in any struggle my new pacemaker would be displaced, but sometimes you just had to get on with it. After a period of shadow boxing, his wife Odette persuaded him to embrace her, and I did the deed from the rear. He was not happy with me, it must have been very painful, but within a very short time he was on his knees, then lying down and soon snoring. Ben produced a straightjacket, the ambulance arrived and they took him off to Littlemore Mental Hospital.
Intermittent Home Treatment of Epileptic Relapses with Diazepam
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Home treatment for relapsing paroxysmal disorders has been advocated in the past but has been generally abandoned either because the agents proved ineffective (for example, the use of oral phenobarbital for the prophylaxis of febrile convulsions) or because, though often effective, they lack sufficient safety margins for general use. An example of the latter would be the time-honored paraldehyde enema (see Chapter 73). Though peak blood levels can be achieved by intramuscular injection (15 ± 5 minutes), faster if given i.v., the rectal route (0.1 to 0.3 ml/kg mixed with 2 volumes of olive or cottonseed oil) can be slow and erratic (1). Another disadvantage for home use of paraldehyde is its rapid deterioration, requiring always fresh preparations. Its frequent use by rectal enema may cause significant local irritation, and it is generally contraindicated in subjects with known respiratory ailments. The rectal administration of tribramethanol (Avertin) has been advocated, but its frequent effects on blood pressure and respiration bar its use without close medical supervision. There are a couple of reports that suggest that lorazepam (LZP) may be a possibility for intermittent home prophylaxis (see Chapter 38).
What Were the Nursing Practices of Mental Health Nurses in Mental Institutions 1800 to 1960: A Scoping Review
Published in Issues in Mental Health Nursing, 2023
Thirteen papers were categorised under the somatic era, or the rise of a scientific approach to the treatment and care of people in asylums (Boschma, 1999a, 1999b, 2019; Boschma et al., 2005; Chung & Nolan, 1994; Dooley, 2004; Gournay et al., 1998; Harmon, 2005; Hopton, 1997; McCrae, 2014; Nolan, 2021; Sands, 2009; Vogel, 1991). The treatments listed above continued, such as supervising patients who worked in the laundry, kitchen or farm (Chung & Nolan, 1994), but now new therapies requiring intensive nursing care were introduced by psychiatrists. Given patients spent much of their time in bed, particularly in the early weeks following admission, intensive nursing care was required. Nurses also played a key role in preparing and caring for patients undergoing electroconvulsive therapy (ECT). Other tasks included identifying and sterilising surgical instruments, wound care, regular recording of patients’ vital signs, administering medications such as paraldehyde to treat convulsions, as well as cardiazol, metrazol and insulin as part of shock therapies, and assistance at lobotomies (Dooley, 2004; McCrae, 2014; Nolan, 2021; O'Brien, 2001). Nurses also assisted in injecting patients malaria as fever treatment, was thought to cure psychosis (Sands, 2009).
Craniocerebral nail gun injuries: a definitive review of the literature
Published in Brain Injury, 2021
The first case documented a 19-year-old male with a single intracranial nail injury who developed early seizures in the setting of meningitis (on day four post-injury). This was treated with paraldehyde, dilantin, and phenobarbitone (29). The second case involves a 28-year-old male with a single intracranial nail, who developed a tonic-clonic seizure lasting 5 min on day 5 post-injury. This early seizure was successfully treated with phenytoin (9). The final case pertains to a 17-year-old male with 24 intentional intracranial nails. He suffered a late partial seizure of his left arm (2 weeks after his injuries) and responded to an increased dosage of phenytoin (30).
Neonatal seizures treatment based on conventional multichannel EEG monitoring: an overview of therapeutic options
Published in Expert Review of Neurotherapeutics, 2022
Isotta Guidotti, Licia Lugli, Luca Ori, Maria Federica Roversi, Elisa Della Casa Muttini, Luca Bedetti, Marisa Pugliese, Francesca Cavalleri, Francesca Stefanelli, Fabrizio Ferrari, Alberto Berardi
Finally, the pharmacokinetics of 2nd-line ASMs were addressed in a further systematic review [53]. This review highlights the paucity of data on the pharmacokinetics of carbamazepine (CBZ), LID, paraldehyde, topiramate (TPM), valproic acid (VPA), and vigabatrin (VgB).