June 7, 2021

Background: Droperidol came onto the market in 1967 and, over time, became a frequently employed treatment of headache, nausea, agitation, acute pain, chronic pain, pain in the context of opioid-tolerance and refractory abdominal pain.  Unfortunately, in December 2011, the US Food and Drug Administration placed a black box on droperidol due to surveillance data showing increased prevalence of QT prolongation.  Most of these cases were due to high doses of droperidol ranging from 50 to 100 mgs. It’s also important to point out that QTc prolongation is not a patient centered outcome. A trial published by Nuttall et al of over 20,000 patients found ZERO cases of polymorphic VT or death at low doses of droperidol (0.625mg) [3].  Additionally, the Clinical Guidelines Committee of the American Academy of Emergency Medicine (AAEM) reviewed the literature in 2014 and found no evidence that low dose droperidol (under 2.5mg) was unsafe for use [4].

February 22, 2021

Background: Emergency Medicine clinicians must be adept in the management of the agitated patient. While verbal de-escalation techniques should be attempted, they are often inadequate. The next option after attempts at verbal de-escalation is chemical restraint with medications to help with a more rapid decline in agitation. Although it is agreed that IM antipsychotics or benzodiazepines are first line medications to treat agitation, there is no consensus on any one single agent. The big question therefore, still remains however of what medications should we use and at what dose? There are numerous papers investigating the utility of various medications. Today, we look at a comparison of droperidol, ziprasidone and lorazepam.