(Geodon) in EMS - Gathering of Eagles
(Geodon) in EMS - Gathering of Eagles
(Geodon) in EMS - Gathering of Eagles
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Ziprasidone(<strong>Geodon</strong> R ) <strong>in</strong><strong>EMS</strong>
<strong>Geodon</strong> (ziprasidone)u Unable to obta<strong>in</strong> any droperidol orhaloperidol at this time.u Due to concerns for the safety <strong>of</strong> ourresponders and our patients, weneeded to f<strong>in</strong>d an acceptablesubstitute.
<strong>Geodon</strong> (ziprasidone)<strong>EMS</strong>u What is unknown- very fewstudies have looked at the use<strong>of</strong> chemical restra<strong>in</strong>t agents <strong>in</strong>the pre- hospital sett<strong>in</strong>g.
Chemical Restra<strong>in</strong>t <strong>in</strong> <strong>EMS</strong>Options with currentMedication ShortagesJON JUI MD, MPH
Multnomah County <strong>EMS</strong>Chemical Restra<strong>in</strong>t Protocol
<strong>Geodon</strong> (ziprasidone)u When rapid control <strong>of</strong>acute agitation isnecessary to prevent harmto patient or staff
<strong>Geodon</strong> : Examples <strong>of</strong> PatientPresentationsu Found runn<strong>in</strong>g naked and manic through street. Pt stabbedhimself multiple times, restra<strong>in</strong>ed by police.u Smok<strong>in</strong>g crack, rag<strong>in</strong>g mad, hit bus station employee, yell<strong>in</strong>gobscenitiesu Broke out basement w<strong>in</strong>dows, try<strong>in</strong>g to escape from aliensu Patient scream<strong>in</strong>g and yell<strong>in</strong>g at police tell<strong>in</strong>g <strong>EMS</strong> to arrestpolice s<strong>in</strong>ce they violated CIA law.u Neighbor call PPD pound<strong>in</strong>g on door. Patient <strong>in</strong> chicken coopstat<strong>in</strong>g snipers out to get him.
<strong>Geodon</strong> (ziprasidone)u Fifth atypical antipsychoticmedication to ga<strong>in</strong> FDA approval <strong>in</strong>2001.u We have been us<strong>in</strong>g it <strong>in</strong> emergencydepartments safely for over 10 years.
<strong>Geodon</strong> (ziprasidone):Packag<strong>in</strong>gu A: <strong>Geodon</strong> for<strong>in</strong>jection is available ass<strong>in</strong>gle dose vial 20 mg/mL.
<strong>Geodon</strong> (ziprasidone) :Costu <strong>Geodon</strong> is approximately $20.00per dose compared to $4.00 fordroperidol.
<strong>Geodon</strong> <strong>in</strong> <strong>EMS</strong>Results <strong>of</strong> 1 st Twomonths deployment
<strong>Geodon</strong> <strong>in</strong> <strong>EMS</strong>u From August 13, 2012to October 25, 2012u 32 Consecutivecases
<strong>Geodon</strong> : Patient Ages
<strong>Geodon</strong> <strong>in</strong> <strong>EMS</strong>DemographicsNumberPercentFemales 11 35%Males 21 65%Total 32 100%
<strong>Geodon</strong> : SceneIndicationsNoYesDanger Self 19 13Danger Others 3 29LE Present 9 23
<strong>Geodon</strong> : Underly<strong>in</strong>gPMHNOYESETOH 27 (84%) 5 (16%)Diabetes 32 (100%) 0 (0%)Street Drugs 25 (78%) 7 (22%)Cardiac 32 (100%) 0 (0%)Psych 16 (50%) 16 (50%)Seizure 31 (96%) 1 (3%)Head Injury 31 (97%) 1 (3%)
<strong>Geodon</strong>Efficacy
<strong>Geodon</strong> (ziprasidone)Time onset <strong>of</strong> Effectsu A: The most likely earliest onset <strong>of</strong> thesedation effects <strong>of</strong> <strong>Geodon</strong> isapproximately 15-20 m<strong>in</strong>utes.u In most cases, the agitation will bemarkedly decreased <strong>in</strong> 30 to 45m<strong>in</strong>utes.
Behavioral Activity Rat<strong>in</strong>g Scaleu 1 = difficult or unable to rouseu 2 = asleep but responds normally to verbal orphysical contactu 3 = drowsy, appears sedatedu 4 = quiet and awake (normal level <strong>of</strong> activity)u 5 = signs <strong>of</strong> overt (physical or verbal) activity,calms down with <strong>in</strong>structionsu 6 = extremely or cont<strong>in</strong>uously active, not requir<strong>in</strong>grestra<strong>in</strong>tu 7 = violent, requires restra<strong>in</strong>t
<strong>Geodon</strong> (ziprasidone)
<strong>Geodon</strong> (ziprasidone)
<strong>Geodon</strong> (ziprasidone)
<strong>Geodon</strong> : Efficacy <strong>of</strong>SedationYesEffect None 0 %Effect M<strong>in</strong>imal 12 (46%)Effect Complete 13 (40%)
<strong>Geodon</strong>: Time to EffectObserved
<strong>Geodon</strong>Adverse Effects
<strong>Geodon</strong> (ziprasidone) vsHaldol QT Prolongation
<strong>Geodon</strong> (ziprasidone)Side Effectsu Sedation,u Hypotensionu Extrapyramidal symptoms (EPS)
<strong>Geodon</strong> (ziprasidone)u prolongs QT and causeTorsades
<strong>Geodon</strong> Summary
<strong>Geodon</strong>: Summaryu <strong>Geodon</strong> was effective <strong>in</strong> decreas<strong>in</strong>g agitationis approximately 50% <strong>of</strong> the patientsu Onset <strong>of</strong> effect was approximately 15-20m<strong>in</strong>utesu No adverse effects were identified.u Most likely the rema<strong>in</strong>der <strong>of</strong> the effect wasobserved <strong>in</strong> the ED (work <strong>in</strong> progress)
The END
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