Management of Panic Attack in Patient with Abdominal Wound Infection
Yes, the patient should be given lorazepam 0.5 mg now for her panic attack despite it being scheduled for 0900. 1, 2
Rationale for Early Administration
- Lorazepam is indicated for acute anxiety and panic attacks, and can be administered as needed for situational anxiety 1
- The FDA label for lorazepam states that "for anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily" and dosing should be "individualized according to patient response" 1
- Benzodiazepines like lorazepam provide rapid control of anxiety symptoms without interfering with ongoing medical treatment 2
- For acute situational anxiety (like a panic attack), prompt intervention is appropriate rather than adhering strictly to scheduled times 2
Dosing Considerations
- The requested dose of 0.5 mg is within the safe range and is actually on the lower end of the recommended dosing spectrum 1
- For anxiety, the FDA recommends 1-2 mg/day for elderly or debilitated patients, and the patient's current dose of 0.5 mg is even lower than this conservative recommendation 1
- Lower doses (0.25-0.5 mg) are specifically recommended for patients who may be frail or have medical conditions 2
Safety in Patient with Abdominal Wound Infection
- There are no specific contraindications to using lorazepam in a patient with an abdominal wound infection 3
- Lorazepam has a favorable safety profile for short-term use in managing acute anxiety 2
- Pain control is important after abdominal procedures to limit postoperative complications, and anxiety can exacerbate pain perception 3
Administration Considerations
- Lorazepam can be administered orally with rapid effect for anxiety symptoms 1
- The medication can be mixed with liquid or semi-solid food if needed for administration 1
- Document the early administration and the reason (panic attack) to ensure proper medication tracking 3
Monitoring After Administration
- Monitor the patient for response to the medication within 60 minutes of oral administration 3
- Assess for potential side effects such as excessive sedation 3
- Consider whether additional interventions may be needed if the panic attack is not adequately controlled with the initial dose 2
Follow-up Plan
- Evaluate whether the regular scheduled dose at 0900 should still be administered or adjusted based on the response to this early dose 1
- Consider whether environmental modifications (such as opening the blinds that triggered the panic attack) should be implemented 3
- Assess whether the patient requires additional psychological support or interventions for anxiety management 2