15/37

                              SAR  (Senior Admitting Resident)  Intensive Care Unit
8/24/93         23 year old male  history  panic disorder treated by
psychiatrist father with Xanax  high dose.  Apparently was on
Xanax taper or discontinued.  Patient had seizure 8/21 and
admitted.  Had negative CT.  felt to be syncopal seizure.  Patient
exhibited bizarre behavior and psychiatry consulted.  Patient
became psychotic and talking delirious.  Further history revealed
Xanax and withdrawal suggested.  Transferred to ICU for 
benzodiazepine sedation and monitor (?=) withdrawal (?, tachycardia,
diaphoretic).
                      On exam patient sedated and delirious, restraints
                      BP 150/90  Heart Rate 120-130  Respiration Rate 14
                      Facial abrasions (?trauma during Seizure)  Lungs Clear
                      to Auscultation (CTA)  ar1,s1,s2,   (illegible)

Click here for image
Click here for previous page

(?Treatment plan:)  Encephalopathy likely secondary (to) withdrawal
                                       - sedate with benzo(diazepine), keep (?BP,
                                                                      pulse, Heart Rate normal)
                                    rather over sedate and intubate than undersedate
                                    and seizure.
                                        - Rule out other cause(?) metabolic (labs)
                                               or infections (do Lumbar Puncture).

                                                      (name uncertain,
                                                        Birch, Berch)

Click here for image
Click here for previous page
Click here for next page
Click here for top of chart