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Muscle relaxant in the filed and helicopters

Andrew J Bowman sumieb at compuserve.com
Wed Apr 19 23:56:54 BST 2006


Well that patient was probably not too "relaxed" (the awake paralyzed
patient) but probably laid very still for the scan

Reminds me of a time I saw a nurse holding a bottle of Anectine
(succinylcholine).  Knowing we were not planning on intubating anybody
anytime soon I asked what she was doing.  She responded that the MD ordered
a dose of Inapsine (droperidol) for a patient.  I calmly removed the bottle
from her hand and did a little quick education.

Andrew

----- Original Message ----- 
From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
To: "Critical Care mailing list Trauma &amp" <trauma-list at trauma.org>;
<xg2k2 at yahoo.com>
Sent: Wednesday, April 19, 2006 6:52 PM
Subject: RE: Muscle relaxant in the filed and helicopters



Ketamine is not a 'muscle relaxant' in any way, shape or form. To avoid
confusion I suggest terminology be limited to 'neuromuscular blockers' or
the old fashioned term 'paralytics'. In English drugs like benzodiazepines
get referred to as 'muscle relaxants' in some contexts (eg general
practice). I'm aware of at least one case where a confused intern wanted to
give an agitated patient something for 'relaxation' in the CT scanner. The
drug chosen was vecuronium.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> xg2k2 at yahoo.com 20/04/2006 5:17am >>>
Eh sorry, that actually was my fault. I recently looked at an article
regarding a correlation between sleep apnea and thoracic aorta dissection,
and somehow managed to invent a new syndrome in my post. When I think of
muscle relaxants in the pre-hospital setting, I believe Ketamine is one of
the more commonly used ones, and recent inquiries into prevalence of
arrythmia along with the apnea can cause certain issues in the ambulance
that may not be equipped to address. Sorry about the confusion, I'm still
trying to refine my ability to present arguments in a semi-formal setting.
:-)

  -Mike F

"Lamb, Keith D." <KLamb at Christianacare.org> wrote:
  What? I didn't understand one thing you just said. Sorry.....maybe it's me
but I don't see how any of this relates to the use of NMB.
What is thoracic apnea? I like the good old fashioned apnea where the
patient stops breathing and the passage of an airway is (theoretically)
easier to accomplish. Apnea is a "desired" result of the use of NMB.

I also don't understand your "dose" comment.

I "think" that one of the biggest concerns about the use of muscle relaxants
pre-hospital is what do they do if they cant facilitate an appropriate
airway after the patient is relaxed. What if they cant maintain a patent
airway and BVM the patient after the relaxant. Then they (pre-hospital
personnel) would have to do the same thing that we would do in-hospital, and
put a hole in the patients neck.

Problem is of course that it is much more difficult to find a surgeon in the
back of an ambulance.

Keith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Michael Ferker
Sent: Wednesday, April 19, 2006 14:17
To: Trauma &, Critical Care mailing list
Subject: Re: Muscle relaxant in the filed and helicopters


I think that the high potential for arrythmia, bradycardia, thoracic apnea,
or even straight up larynx spasms make me suspicious of administering muscle
relaxants (atleast in high doses) outside of a hospital.

-Mike F

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