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Sun Sep 16 04:27:15 BST 2007

Sux is NOT contraindicated in ACUTE spinal cord injury or acute burns. Sux is a major problem in CHRONIC spinal cord injury due to up regulation of the acetylcholine receptors and massive potassium release. In acute trauma give sux as necessary to safely manage the airway.

Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Director of Clinical Research, Sydney West AHS
Clinical Lecturer, University of Sydney

>>> roydanks at hotmail.com 15/09/2007 1:09pm >>>
I think you have your meds confused.  With some anesthetics we worry about malignant HYPERthermia.  Succinylcholine is not one (I don't think, but I'm not in anesthesia).  But you don't give succs to spinal cord injuries or acute burns because of hyper(?)kalemia (Ragnar, et al, you are welcome to correct me).  He wouldn't necessarily be intubated if the injury is low enough.  Recall that C3-4-5 keep the diaphragm alive.  I think he was C6.

Medical cardiac arrest, traumatic cardiac arrest and acute spinal cord injuries are three VERY different animals...I wouldn't get too excited over a few saves.  

RRD

> Date: Fri, 14 Sep 2007 13:05:50 -0700> From: fpcems at yahoo.com> To: trauma-list at trauma.org> Subject: RE: NFL player recoverey> > I was watching national news last nite, and I guess the hypothermia was started bycool IV therapy was started in the ambulance. Whatever happened after that, couldnt say. I would assume that this patient would be intubated....I have a couple of questions about that. Would Succs be indicated or no, b/c of the side effect of maliginant hypothermia? > > I believe a field trial of induced hypothermia post cardiac arrest is happening or is going to happen with Boston EMS. There is an article about a saved patient and this therapy on boston.com. > > dave> > > Roy Danks <roydanks at hotmail.com> wrote:> I echo your comments. Sounds great, but as I read the USA Today article, I cringed....however did the team physician get the goods to start the therapy in the ambulance? How is this covered by the > > > > Nuremberg Code - Declaration of Helsinki> > It sounds good. He may walk again...they're doing it at a big research facility. But it certainly makes one wonder what would be the response if the player's outcome hadn't been so (apparently) favorable.> > We work hard to get protocols through IRBs, things like this could potentially set us back.> > > > > > > From: KMATTOX at aol.com> Date: Thu, 13 Sep 2007 22:10:00 -0400> To: trauma-list at trauma.org> Subject: Re: NFL player recoverey> > We each have and will be asked to treat future patients with similar > protocols. We MUST be sure that any such treatment be via an IRB approved tightly > controled protocol. I have searched and searched for OUTCOME data to > support both the continuing use of steroids or this new HYPOTHERMIA treatment, > or even early decompression in acute spinal cord injury. By outcome, I am > talking about a favorable FUNCTIONAL outcome, not the hocus pocus non > functional tiny change reports from the several methylprednisolone studies. > > Because we are going to be innundated with questions, does anyone know the > exact protocol used in Miami and in this patient. Was there a lamenectomy. > Was there local hypothermia, what drugs were used. Were steroids used. > What has been the exact functional improvement and in how many patients?> > Even some of the> hypothermia in cardiac and stroke patients is marginal. > We are all being asked to buy cooling cradles and blankets for regional EMS > mandated protocols, with very very marginal , but marketing, information. ONE > MUST NOT equate the studies in MI and stroke to cervical spinal cord injury. > > > k> > > > ************************************** See what's new at http://www.aol.com> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> _________________________________________________________________> More photos; more messages; more whatever * Get MORE with Windows Live* Hotmail®. NOW with 5GB storage.> http://imagine-windowslive.com/hotmail/?locale=en-us&ocid=TXT_TAGHM_migration_HM_mini_5G_0907--> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> > > > ---------------------------------> Be a better Heartthrob. Get better relationship answers from someone who knows.> Yahoo! Answers - Check it out. > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/ 
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NFL player recoverey