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2. RE: just BLS them.... (Eran Tal-Or)

Eran Tal-or e_talor at rambam.health.gov.il
Fri Apr 21 08:52:07 BST 2006


I use Ketamine over 20y now and I believe that know this drugs effect
and indication. I never said that Ketamine is not hypnotic. Further more
Ketamin is hypnotic and analgesic. The use in Ketamine in the pre
hospital starts when we look for drug that will not stop the breathing
of the pt and will be homodynamic stable. That was also the cause for
not let the paramedics and army physician use muscle relaxants in the
pre-hospital. More then once pt was transport to the hospital with
esophageal intubations and the good thing was that they were breathing
spontaneously.  That is the reason that it still not in use in
pre-hospital environment. The question comes out again when we
accomplish the task that every ALS unit has ETCO2 monitoring. Now there
a confirmed way to know where the tube is and we have second thought
about letting the pre-hospital ALS provider to use muscle relaxants. 
            

Eran Tal-Or M.D. M.H.A. 
Trauma Unit
Rambam Mediacl Center

|-----Original Message-----
|From: trauma-list-bounces at trauma.org [mailto:trauma-list-
|bounces at trauma.org] On Behalf Of C M
|Sent: Thursday, April 20, 2006 1:08 PM
|To: trauma-list at trauma.org
|Subject: 2. RE: just BLS them.... (Eran Tal-Or)
|
|Eran, you may want to understand what Ketamine actually does before you
|discount it's hypnotic effect...........what exactly does dissociative
mean
|anyways?  I do not use ketamine for RSI, that is not what it is
indicated
|for, however it may actually have some use in the field in the future,
I
|think it would be worth studying for prolonged traumatic extrication, I
|don't think that it can be discounted without "scientific based
evidence".
|
|  And in response to your question regarding muscle relaxants in the
filed
|(I think you meant "field") I've never used soma for intubation, but
maybe
|I will consider it instead of a paralytic, I'll have to check to see if
I'm
|allowed via our protocols/guidelines
|
|  With sarcasm out of the way, I believe that there are indications for
|intubating in the field, and I believe that there are times where our
|patients need a surgeon's knife far more than they need to be waiting
for
|RSI to take affect in the field.  The folks who understand the
difference
|are justifiably insulted when treated as though we are mice in a maze
|looking for cheeze.  I have flown fast with ambu bag in hand and no
tube
|more than once, however upon arrival in the ED I was met with, "why
didn't
|you intubate?"  Sometimes it's best not to question why.
|
|  Cheers.
|
|
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