13/37
(Continuation of note of Dr. David Sagman 8/24/93)
puncture (after discussing with patient's
father). What I thought was
convulsive syncope, almost certainly
was a withdrawal seizure.
D.L. Sagman
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8/23/93 Note of Intern Dr. Noah Berkowitz
(incorrect date is listed on his note. Correct date is 8/24/93)
Patient exhibits a waxing & waning delirium.
characterized by disorientation & visual and possibly auditory
hallucinations. The patient is on Ativan.
After discussing the case with Drs. Sagman and Collins, the
decision has been made to perform a L(umber)P(uncture) on the patient.
Dr. Collins suggested Morphine to control the patient's
current agitation during the procedure
This was discussed with the patient's father who consented
to the procedure performed by me
transfer note to follow
(Initials of Noah Berkowitz, M.D.) 7089
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8/24/93 Psych(iatry) Addendum
12:40 PM Patient's BP 150/70 (following Morphine Sulphate) 10mg,
Heart Rate=120, Temperature 100.5 Degrees.
Patient continues delirious with periods of agitation - shaking his
legs violently while in restraints.
While Xanax withdrawal is the most likely cause of
the seizure/delirium, I would recommend that other causes
be ruled out. I agree (as above) with the recommendation for
Lumbar Puncture. Also - would repeat head CT(scan) - in case
(? ) his head injury--->subdural bleed.
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(continuation of Dr. Collins' Psych Addendum)
I feel he should be monitored in the Intensive Care Unit. I would
hold neuroleptics for management of agitation, as they lower
the seizure threshold. Would increase Ativan to 4mg every 3 hours or
2 mg every 2 hours o(r) more - until vital signs (Blood Pressure, Heart Rate)
are stable. Patient's father, Dr. Speken, suggests using Xanax - as Xanax may
be peculiar among benzodiazepines in the difficulty we have in tapering
people off it. However, we need to prophalax against seizure,
and I feel it is safer to give a medication IV or IM (like Ativan). Could
use IV Valium (must be pushed slowly). - Will give Ativan IV Push
2 mg. at once
Discussed with Dr. Vogel
Initials of Dr. E. Collins
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8/24/93 MAR (?Medical Admitting Resident)
12:45PM Transfer to ICU for direct observation/monitoring/sedation in
setting of acute benzodiazepine withdrawal
(signature unclear)
(? ICU aware)
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