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Mon Oct 20 12:52:23 BST 2003

----- Original Message -----
From: "John Holmes" <docjohnholmes at hotmail.com>
To: <trauma-list at trauma.org>
Sent: Thursday, October 16, 2003 6:43 AM
Subject: Re: Helicopter transport & head injury


> If intubation is required for optimal management of the head injury
> (maintenance of adequate oxaemia, avoidance of hypercarbia etc) then the
> intubation should preceed.
>
> Alternatively, If there is a significant risk in the helicopter for loss
of
> control of the airway then intuabtion should be done prior to flight for
> that reason too.  In general we would have a lower threshold for
intubating
> if helicopter transport is being used.  In this context the presence or
> otherwise of a head injury is irrelevant - you seem to be implying that HI
> is in some way a contraindication for intubation.  The reverse is the
case.
>
> John
>
> John L Holmes
> Director Emergency Medicine
> Mater Hospital, Broisbane
> (temp ED locum, Galway University College Hospital, Ireland)
>
> >From: "Black, John" <John.Black at orh.nhs.uk>
> >Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> >To: 'Trauma & Critical Care mailing list' <trauma-list at trauma.org>
> >Subject: Helicopter transport &  head injury
> >Date: Mon, 13 Oct 2003 16:59:55 +0100
> >
> >Colleagues,
> >
> >Picking up the thread of hazardous potential problems arising in flight
> >(e.g. vomiting), under what circumstances would you advocate undertaking
> >rapid sequence intubation prior to helicopter transport in the context of
> >significant head injury, assuming that there are the resources available
to
> >undertake this?
> >
> >
> >John Black
> >John Radcliffe Hospital
> >Oxford, UK
> >
> >
> >
> >Our copter flies 50 - 60 flights per month.  Less than 1% of patients
have
> >any trouble with nausea and vomiting.  We do not give the patients
anything
> >for airsickness.  It isn't a problem for us.  (of course, now that I have
> >talked about it the next 15 patients will vomit and aspirate!)
> >
> >E
> >
> >Errington C. Thompson, MD, FACS
> >Trauma Surgeon
> >Trinity Mother Frances
> >Tyler, Tx.
> >ecthompson at msn.com <mailto:ecthompson at msn.com>
> >
> >Don't think you are
> >Know you are
> >
> >                            - Morpheus (The Matrix)
> >----- Original Message -----
> >From: Chris + Mandy Cresswell
> ><mailto:chris.mandy.cresswell at paradise.net.nz>
> >
> >To: Trauma  <mailto:trauma-list at trauma.org> & Critical Care mailing list
> >Sent: Saturday, October 04, 2003 1:47 AM
> >Subject: Re: anti-emetics after head injury
> >
> >Yep, we do that to.  Do use use an antiemetic?
> >
> >Regards
> >
> >Dr Chris Cresswell
> >Medical Officer
> >Turoa and Whakapapa Ski Fields
> >Mt Ruapehu
> >New Zealand
> >----- Original Message -----
> >From: E C Thompson <mailto:ecthompson at msn.com>
> >To: Trauma  <mailto:trauma-list at trauma.org> & Critical Care mailing list
> >Sent: Friday, October 03, 2003 5:34 PM
> >Subject: Re: anti-emetics after head injury
> >
> >In a patient without facial fractures, we use an NG tube.
> >
> >E
> >
> >Errington C. Thompson, MD, FACS
> >Trauma Surgeon
> >Trinity Mother Frances
> >Tyler, Tx.
> >ecthompson at msn.com <mailto:ecthompson at msn.com>
> >
> >Don't think you are
> >Know you are
> >
> >                            - Morpheus (The Matrix)
> >----- Original Message -----
> >From: Chris + Mandy Cresswell
> ><mailto:chris.mandy.cresswell at paradise.net.nz>
> >
> >To: trauma-list at trauma.org <mailto:trauma-list at trauma.org>
> >Sent: Thursday, October 02, 2003 4:10 AM
> >Subject: anti-emetics after head injury
> >
> >Greetings.  What do you use (if anything) as a prophylactic antiemetic
> >after
> >a head injury.  Our helicopter paramedics request antiemetics be given
> >before flight.  I routinely use haloperidol as an antiemetic but the
> >surgeons at one of our recieving hospitals don't like it as they think it
> >may over sedate people (even though most people we use it on in
antiemetic
> >doses (eg 4mg for an adult have no noticable sedation, or may decrease
> >seizure threshold (is this a real or just a theoretical effect).  I note
> >Tintinalli [Emergency Medicine, text by American College of Physicians]
> >recommends droperidol for post head injury agitation - therefore
> >haloperidol
> >should be OK shouldn't it?
> >Any thoughts, evidence, recommendations for cheap antiemetics or advice
> >against using antiemetics at all would be much appreciated.
> >Regards
> >Dr Chris Cresswell
> >Medical Officer
> >Turoa and Whakapapa Ski Fields
> >Mt Ruapehu
> >New Zealand
> >
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Helicopter transport & head injury