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APR
27

Episode 43 – Droperidol Black Box Warning

The EMS Lighthouse Project


EMSLightHouseBlog

Episode E43 – mRNA Vaccines – Real World Efficacy

We saw the amazing performance of the two mRNA COVID vaccines from Pfizer and Moderna in their RCTs. As encouraging as trial performance is, we always want to see how those numbers hold up under large scale, real-world pragmatic conditions. Well, we now have three new pieces of information on that. And, for the cherry on top, we get evidence of performance against asymptomatic infection! Dr. Jarvis does a quick review of the latest evidence on vaccine performance.

 

 

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Show Notes

Papers reviewed:

  1. Amit S, Beni SA, Biber A, Grinberg A, Leshem E, Regev-Yochay G. Postvaccination COVID-19 among Healthcare Workers, Israel. Emerg Infect Dis 2021; 27, 1220-1222.
  2. Dagan N, Barda N, Kepten E et al. BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. N Engl J Med 2021;
  3. Thompson MG. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA- 1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021. MMWR Morb Mortal Wkly Rep 2021;
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APR
01

Episode 42 – Droperidol Black Box Warning

The EMS Lighthouse Project


EMSLightHouseBlog

Episode 42 – Droperidol Black Box Warning

December 4, 2001. A bad day, indeed. That’s the day the FDA issued a black box warning for droperidol, citing evidence of QT prolongation, Torsades de Pointes, and death. This was a surprise warning because droperidol had been extensively used by emergency medicine and anesthesiology for decades without apparent problems. Since this bad day, we’ve essentially been without droperidol. Fortunately, it’s back! Before we start using it again, we should take a look at what got this drug on the FDA’s radar. Dr. Jarvis reviews the literature about the “evidence” behind the warning and describes how his systems will be bringing droperidol back into practice.

 

 

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Show Notes

Bibliography

  1. Brice JH, Pirrallo RG, Racht E, Zachariah BS, Krohmer J. Management of the violent patient. Prehosp Emerg Care 2003; 7, 48-55.
  2. Calver L, Drinkwater V, Gupta R, Page CB, Isbister GK. Droperidol v. haloperidol for sedation of aggressive behavior in acute mental health: a randomized controlled trial. Br J Psychiatry 2015; 206, 223-228.
  3. Calver L, Page CB, Downes MA et al. The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Ann Emerg Med 2015; 66, 230-238.e1.
  4. Calver L, Isbister GK. High dose droperidol and QT prolongation: analysis of continuous 12‐lead recordings. British Journal of Clinical Pharmacology 2014; 77, 880-886.
  5. Cole J, Lee S, Martel M, Smith S, Biros M, Miner J. The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department. Western Journal of Emergency Medicine 2020; 21
  6. Colwell CB. Managing the acutely agitated patient. Why Denver brought back the forgotten agent droperidol. EMS Mag 2010; 39, I8-9.
  7. Henzi I, Sondereggeer J, Tramer MR. Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Aneth 2000; 47, 537-551.
  8. Hick JL, Mahoney BD, Lappe M. Prehospital sedation with intramuscular droperidol: a one-year pilot. Prehosp Emerg Care 2001; 5, 391-394.
  9. Horowitz BZ, Bizovie K, Moreno R. Droperidol-Behind the Black Box Warning. Acad Em Med 2002; 9, 615-618.
  10. Isbister GK, Calver LA, Page CB, Stokes B, Bryant JL, Downes MA. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med 2010; 56, 392-401 e1.
  11. Kao LW, Kirk MA, Evers SJ, Rosenfeld SH. Droperidol, QT prolongation, and sudden death: what is the evidence. Ann Emerg Med 2003; 41, 546-558.
  12. Khokhar MA, Rathbone J. Droperidol for psychosis-induced aggression or agitation. Cochrane Database Syst Rev 2016; 12, CD002830.
 
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