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Thu Aug 2 22:19:57 BST 2007

Kind of Markus to post that editorial; very helpful. My drug of choice in
this circumstance is, and has been for some years, ketamine. I teach it
should NOT be co-administered with a benzodiazepine out of hospital as this
can destroy some of the advantages of ketamine in terms of preservation of
airway reflexes and respiration. It can be used in sub-anaesthetic doses
(around 0.5mg/kg) as a fantastic analgesic during extrication and you can
simply titrate it to response to give deeper and deeper sedation until you
get to around 3mg/kg when the patient is anaesthetised. Even better, given
at 10mg/kg *IM* it will give a smooth induction of anaesthesia. The only
time to use a benzo is if the patient on waking is showing signs of
emergence phenomena. If it is used in the field keep the patient on bolus
ketamine in transit and wake if required in the ED.

Blueflightmedic.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Hardcastle, Tim, Dr <tch at sun.ac.za>
Sent: 02 August 2007 19:09
To: Trauma &amp; Critical Care mailing list
Subject: RE: Etomidate and RSI

John

Thanks - small study, but interesting result. They don't comment on
mortality difference though!! The also don't specify injury type and mix -
ISS is notoriously unreliable to compare groups given the huge variables
that determine the score.

At least it is food for thought. Attached find an article I put together
reviewing the available literature on the subject, which is yet to be
published (Journal of Trauma did not want it - they rejected it as it only
focussed on Etomidate, rather than all RSI drugs!). Still begs the question
as to what good alternatives are available?

Not sure if I should even try to submit it anymore given the latest study. 

Thanks too to all who responded to my original query
Regards
Tim
Dr T C Hardcastle 
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA) 
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) 
ATLS  instructor and DSTC Cape Town Course Director 
Intern program Coordinator: Surgery 
M.Med (Emergency Medicine) Executive Committee member 
Clinical Head (Director): Diana Princess of Wales Trauma Unit 
Division of Surgery (General) Room 4064 
Department of Surgical Sciences 
Tygerberg Hospital / University of Stellenbosch 
PO Box 19063 
Tygerberg 7505 
Western Cape 
South Africa 
e-mail: tch at sun.ac.za 
Cell: +27824681615 
Office: +27219389281 or 4911 pager 0302 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Green, John
Sent: Thursday, August 02, 2007 6:47 PM
To: trauma-list at trauma.org
Subject: Etomidate and RSI

There is a nice pilot study to be presenteed at the upcoming AAST in
September that examines this specifically.  The abstract is available on the
AAST website. http://www.aast.org

John M. Green, M.D.
Section of Acute and Critical Care Surgery
Washington University in St. Louis

  _____  

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Sent: Thu 8/2/2007 10:59 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 50, Issue 3

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Etomidate and RSI