›1 to 2 mg IV every 5 to 10 minutes titrated to effect
›Maximum 8 to 10 mg in first hour
›Midazolam IV or IM
›2 to 5 mg IV or 5 to 10 mg IM for rapid control
›Repeat every 5 minutes as needed
›Diazepam IV
›5 to 10 mg IV every 5 to 10 minutes
›Maximum 30 mg initial episode
›Refractory agitation or seizures
›Phenobarbital IV
›15 to 20 mg/kg IV loading dose at 50 to 100 mg/min
›Respiratory depression monitoring
›Propofol infusion for intubated patients
›5 to 50 mcg/kg/min titrated
›Propofol infusion syndrome monitoring with prolonged high-dose use
›Antipsychotic avoidance
›Haloperidol and droperidol risk additive QTc prolongation
›SC compounds inhibit hERG K+ channel
›Risk of fatal arrhythmia if QTc already prolonged
Cardiovascular management
›Tachyarrhythmia management
›ECG and continuous cardiac monitoring mandatory
›QTc > 500 ms threshold for intervention consideration
›Correct electrolyte abnormalities: potassium and magnesium
›Avoid antipsychotics for QTc prolongation risk
›Benzodiazepines preferred for agitation
›Hypertensive urgency
›Benzodiazepines often sufficient
›Nicardipine 5 mg/hr IV if persistent hypertensive emergency
›Bradycardia and hypotension management
›Atropine IV for symptomatic bradycardia
›0.5 mg IV every 3 to 5 minutes
›Maximum 3 mg total dose
›Shown to improve hemodynamics and mental status in SC toxicity
›Vasopressors for refractory hypotension
›Norepinephrine 0.1 to 0.5 mcg/kg/min IV infusion
›Titrate to MAP >= 65 mmHg
Brodifacoum coagulopathy treatment
›Vitamin K1 (phytonadione) therapy
›Initial IV dosing
›Vitamin K1 20 mg IV every 8 hours initially
›Administer slowly to reduce anaphylaxis risk
›Monitor INR at 24 hours
›Transition to oral therapy
›Vitamin K1 20 mg PO three times daily
›Treatment duration weeks to months required
›Brodifacoum half-life up to 16 to 24 months in fat tissue
›INR monitoring
›Daily INR during initial hospitalization
›Twice to three times weekly monitoring after discharge
›Dose titration to INR < 2
›Fresh frozen plasma
›Immediate reversal for life-threatening hemorrhage
›15 ml/kg IV
›Bridge until vitamin K1 takes effect
›Four-factor PCC consideration
›Intracranial hemorrhage or critical bleeding
›25 to 50 units/kg IV
›Hematology consult recommended
›Transfusion support
›Packed red blood cells for hemoglobin < 70 g/L with active bleeding
›Platelet transfusion if thrombocytopenic with active hemorrhage
›Cryoprecipitate if fibrinogen < 1.5 g/L
›Aggressive IV hydration
›Normal saline preferred
›1 L per hour initial rate
›Adjust based on urine output response
›Target urine output 1 to 3 ml/kg/hour
›Urine myoglobin clearance goal
›Monitor for electrolyte dilution
›Electrolyte management
›Hyperkalemia monitoring
›ECG changes as trigger for intervention
›Calcium gluconate 1 g IV for cardiac protection
›Hypokalemia replacement
›Potassium chloride IV 20 to 40 mEq/hour via central line
›Oral supplementation when tolerating PO
›Synthetic cannabinoid withdrawal syndrome
›Onset within 1 to 2 days of cessation
›Insomnia, irritability, low mood, drug craving
›Diaphoresis, nausea, tremor, hypertension, tachycardia
›More severe than cannabis withdrawal
›Psychopharmacology evidence base
›Pharmacological management
›Diazepam PO
›5 to 10 mg PO every 6 to 8 hours
›Taper over 7 to 14 days
›Quetiapine PO
›25 to 100 mg PO at bedtime
›Evidence of symptom relief in withdrawal