MCC Paramedic Program
By Peter Bonadonna, EMT-P
Tranquilizers are divided into two groups, Major Tranquilizers and Minor Tranquilizers.
Major Tranquilizers include phenothiazines, indoles, thioxanthenes, butyrophenones, piperazine, and piperidine compounds. Trade names include drugs such as Haldol, Thorazine, Clozaril and Risperdal. These drugs are also referred to as Neuroleptics and are prescribed most commonly as anti-psychotics and to chemically restrain violent patients. Major tranquilizers are not widely abused by patients. These agents work centrally at specific receptor sites. see dopamine2 blockers. The EMS benefit of using this class of medication is that the patients are chemically restrained. Patients medicated with this class of medication quickly develop dyskinesis (difficult movements), bradykinesis (slow movements), and hypokinesis (decreased strengh). Haldol is often the drug of choice in EMS systems. Usual dosing is dependent upon the situation but a typical adult dose is 2 to 10 mg IM. IV administration is much less common but possible in a crisis. Once medicated, a patent IV line must be maintained, the respirations and ECG should be monitored closely.
!! Paramedics should use chemical restraint only as a last resort as many violent patients have serious medical/Trauma problems and/or have multiple pharmacological agents on-board already (often at toxic or life threatening levels). Administration of Major Tranquilizers and the subsequent potentiation or synergism of an on-board drug can easily lead to fatalities. Major Tranquilizers cannot be reversed, often interfere with the physicians exam and history and often have a long half-life. !!
Minor Tranquiliers (or more correctly called Sedative/Hypnotics) include the Benzodiazepines, known by trade names such as Valium, Xanax, Serax, Ativan, Klonopin, Librium and Tranxene. There are also combination drugs such as Librax. These drugs are very commonly prescribed as anti-anxiety drugs, or anxiolytics. This class of medications has a high abuse potential in the community. They are central nervous system depressants with specific sites of action. see GABA blockers. Sedative/Hypnotics induce a chemical environment that allows rest, relaxation or sleep. They can also induce short-term amnesia if given IV. The patient can be roused and can still fight with full strength if angry or stimulated. This is why we never use them to restrain a violent patient. The primary use of Sedatives in EMS is to induce amnesia to prevent a patient from remembering a painful procedure like cardioversion. While benzodiazepines can be pharacologically reversed with Mazicon/Romazicon, this is dangerous and it is usually safer to support vital signs, intubate, ventilate and wait for the body to filter the sedative out.
September 5, 2001