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Muscle relaxant in the filed and helicopters

Karim Brohi karim at trauma.org
Thu Apr 20 18:47:56 BST 2006


May I sugest that everyone who has read the comments on this conversation press the 'erase' button in their brains now and simply
delete it from their memory.  So many aspects of it were so wrong and so confusing that I would just start again.  Prehospital RSI
is an emotive enough issue without basic facts of anaesthesia being distorted.

Mike F: I appreciate your enthusiasm but a bit of textbook reading does not give understanding and pulling ideas off the top of your
head at your level is not appropriate for this forum.  I would echo Peter's views and suggest that at your stage (if I understand it
you are a biochecmistry student and have little clinical experience) you should probably your ratio of reading to posting should be
around 100:1.  Otherwise the level of discussion is dragged down to a very confusing, disjointed level.

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Andrew J Bowman
Sent: 19 April 2006 23:57
To: Trauma & Critical Care mailing list; xg2k2 at yahoo.com
Subject: Re: Muscle relaxant in the filed and helicopters


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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