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Sat Aug 4 22:23:23 BST 2007

Here's also the summary from Tim's amazingly detailed review:

Conclusion:The literature on the use of Etomidate has much opinion and limited evidence based-research. What is evident from the literature is that Etomidate should probably be avoided in the SEPTIC patient. The safety factor in the use of Etomidate in other types of shock, in particular trauma related shock and head injury is less clear. There does not appear to currently be enough evidence to suggest avoiding Etomidate completely as an emergency induction agent and the benefits may indeed outweigh the risks of AI, which are small at best and treatable with low-dose corticosteroids at worst. The majority of trauma patients will not be septic, unless there is a delay to diagnosis and treatment, rather they may have contamination of wounds, which are best treated by irrigation and prophylactic doses of antibiotics only. On the balance of the available evidence Etomidate “the baby” should not be “thrown out with the bathwater” just yet. What will answer this issue will finally be a randomized trial with a stable comparator drug, in trauma patients only, looking at the specific incidence of AI in this patient group.Ivan

> Date: Thu, 2 Aug 2007 20:08:44 +0200> From: tch at sun.ac.za> To: trauma-list at trauma.org> 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> > _____ > > From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org> Sent: Thu 8/2/2007 10:59 AM> To: trauma-list at trauma.org> Subject: trauma-list Digest, Vol 50, Issue 3> > > > Send trauma-list mailing list submissions to> trauma-list at trauma.org> > To subscribe or unsubscribe via the World Wide Web, visit> http://list.mistral.net/mailman/listinfo/trauma-list> or, via email, send a message with subject or body 'help' to> trauma-list-request at trauma.org> > You can reach the person managing the list at> trauma-list-owner at trauma.org> > When replying, please edit your Subject line so it is more specific> than "Re: Contents of trauma-list digest..."> > > The materials in this email are private and may contain Protected Health Information. If you are not the intended recipient be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this email in error, please immediately notify the sender via return email. > 

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Etomidate OK in trauma