Physostigmine
                                =============
þ Pharmacology etc.
 - Tradename Antilirium
 - unlike quaternary cholinesterase inhibitors (e.g., Tensilon = edrohonium,
   pyridostigmine, etc.)

þ Contraindications:
 - Absolute:  GI or GU obstruction, if on methacholine or has been given Sux or
   similar
 - Relative:

þ Indications:
 - Severe agitation
 - if benzos or haldol/droperidol ineffective, or wish to avoid sedation

þ Bad reports
 - strong vagal tone
 - slows SA node, block AV node
 - may have CNS effects, if given quickly: seizures, especially if intoxicated
   with TCAs
 - most got ipecac as well

þ Burns et al Ann Emerg Med 2000(Apr):374-381.
 - 0.5 mg or 0.02 mg/kg, on monitor, keep atropine and Versed available
 - Benadryl, Jimsonweed, TCA
 - given over about 5 or 10 minutes
 - in 41/43 controlled agitation, 39 of 45 reversed delirium
 - relapses in 100+/- 42 minutes
 - response in about 10 minutes
 - 26/45 needed redoses, 0.5-45 mg
 - benzos didn't work nearly as well despite big doses (mean 53 mg Valium, 31 mg
   Versed) and some needed to be intubated
 - more likely to drink charcoal