List Archives

Thu Feb 2 23:56:00 GMT 2006

It has nothing to do with the delay to hospital--it has to do with the lack of any indication AND its danger, delay or no--you must understand the meds you give and the physiology of shock following trauma  before deciding on meds--do not fall into the trap of thinking you must always DO something--the real art of medical care is knowing when to leave the patient alone and get him transported
ERF

-----Original Message-----
From: Jago Miloguz <japrak at gmail.com>
To: Trauma &amp, Critical Care mailing list <trauma-list at trauma.org>
Sent: Thu, 2 Feb 2006 20:07:24 +0100
Subject: Re: Noradrenaline for Severe Traumatic Brain Injury

what about usage of narcan in spinal shock,espacially in prehospital
conditions?smoeone said if l understood correctly that no vasocontrictors
should be used in pre-hospital treatment,what if the arrival to hospital is
delayed?
ante

On 2/2/06, YoramKl at clalit.org.il <YoramKl at clalit.org.il> wrote:
>
> I totally agree with Eric. No place for vasoactive drugs in prehospital
> trauma care. Hypertonic saline has an advantage in the hypotensive brain
> injured patient. As far as I know, this is the only indication for
> hypertonic saline that is actually evidence based.
> Best wishes
> Yoram Klein
>
> -----Original Message-----
> From: Ben & Rebecca Meadley [mailto:bmeadley at bigpond.net.au]
> Sent: Wednesday, February 01, 2006 11:28 PM
> To: Trauma & Critical Care mailing list
> Subject: Noradrenaline for Severe Traumatic Brain Injury
>
> Dear List,
>
> Metropolitan Ambulance Service (Melbourne, Australia) is currently
> investigating ideal inotropic/vasopressor support for patients suffering
> severe traumatic brain injury, who are hypotensive and refractory to
> crystalloid filling. Currenlty, our guideline stipulates the use of an
> adrenaline (epinephrine) infusion commencing at 5mcg/min for persistent
> hypotension following 20ml/kg Hartmann's solution (Lactated Ringer's).
>
> The literature (for in-hospital management) and current Australian ICU
> management of these patients suggests noradrenaline to be the preferred
> agent, and I was hoping to get some expert input from the list, as to
> whether people think that this agent is appropriate in the prehopsital
> setting. Currently, our flight paramedics use noradrenaline in the mangement
> of the severe sepsis patient. We use syringe drivers so delivery of the
> infusion is not a problem. The suggested guidleline is 20ml/kg Hartmann's,
> commence noradrenaline at 5mcg/min, continue crystalloid filling aiming for
> a SABP of 120mmHg (MAP 80mmHg) with the ultimate aim to reduce vasopressor
> support.
>
> We are aware of the issues surrounding extravasation and tissue necrosis.
> Proximal venous access is suggested as the acceptable site for infusion.
>
> Your thoughts please and thanks in advance.
>
> Ben Meadley
> MICA Paramedic
> Metropolitan Ambulance Service
> Melbourne
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
>
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html

List Archives

For your convenience, find the Trauma List Archive Below

Noradrenaline for Severe Traumatic Brain Injury