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Fri Aug 8 12:25:08 BST 2008

Obviously it goes without saying that sedation for patients in the pre hospital phase can be controversial, and can have many causes, 
I'm sure though we have all seen patients that have needed some type of pharmaceutical "restraint" to allow treatment / prevent injuries 
worsening etc. 

I know in the UK several teams employ combination of Ketamine / midazolam for sedating combative patients. 
Obviously the benefit of Ketamine apart from almost instant , titratable IV response is that it can if necessary be given IM when getting 
IV access is to dangerous or impossible , it also acts as a great analgesic too  
( I know of some UK tactical paramedics who use this approach). I think the important thing is weighing up the risk vs. benefit for that patient. 

Propofol also can have its place and really the important thing is that the practitioner is used to using the drug in question and aware of 
any issues around it (ie short reversal, potential hypotension etc)

By definition would you sedate a patient though for an RSI ? as surely it is no longer an RSI ...just food for thought 

Mark Hellaby BSc (Hons), RODP
ATACC Instructor
Cheshire Fire Service Trauma Instructor
North Cheshire NHS Clinical Skills / Simulation Facilitator

  From: jkaymdc at aim.comSubject: Re: Sedation for combative patientsDate: Thu, 7 Aug 2008 17:24:27 -0500To: trauma-list at trauma.orgi would also be interested in this information. A week ago I was involved ina call for a "trauma" although the individual had driven the pick-up intothe ditch at a slow speed..no damage to the vehicle. However, the person wasshowing signs of "meth" use (possible OD), had experienced a seizure and wasat this time extremely violent, swinging at me and LE each time we attemptedto calm him. The only medication I had available was Valium...IM of course, which waslike spitting in the wind. In the end he was tased 5 times, had received a total of 5 valium IM, 5Valium IV, 4 Ativan IV, and 5 Haldol IM (between pre hospital and hospital)before he was controlled. Suggestions? Jules On Thu, Aug 7, 2008 at 4:39 PM, Sarah CAllier <sarah_callier at yahoo.com>wrote: > What is your openion on the sedation of combative patients? I am involved> in a protocal commitie for EMS, We are looking at establishing protocals to> allow the sedation of combative patients. Pt's that would fit into the> catagory for this treatment would be Psychiatric patientswho are violent and> pose a threat to themselves to the Police and to EMS providers. We will have> strict guidelines for the administration of the medications. We are looking> at using Versed Ativan and possibly the use of Droperidol. We are also> looking at the possibility of sedation for RSI and for combative trauma> patients. Any openions on what is better?>>>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> --Forwarded Message Attachment--From: rogers3 at socal.rr.comSubject: RE: Sedation for combative patientsDate: Thu, 7 Aug 2008 16:10:36 -0700To: trauma-list at trauma.orgAlthough it has been Black Boxed, Droperidol 5-10mg's would drop a large manand keep him asleep for several hours...Did have to watch the bp and o2satsthough.... -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On Behalf Of JulesSent: Thursday, August 07, 2008 3:24 PMTo: Trauma &amp, Critical Care mailing listSubject: Re: Sedation for combative patients i would also be interested in this information. A week ago I was involved ina call for a "trauma" although the individual had driven the pick-up intothe ditch at a slow speed..no damage to the vehicle. However, the person wasshowing signs of "meth" use (possible OD), had experienced a seizure and wasat this time extremely violent, swinging at me and LE each time we attemptedto calm him. The only medication I had available was Valium...IM of course, which waslike spitting in the wind. In the end he was tased 5 times, had received a total of 5 valium IM, 5Valium IV, 4 Ativan IV, and 5 Haldol IM (between pre hospital and hospital)before he was controlled. Suggestions? Jules On Thu, Aug 7, 2008 at 4:39 PM, Sarah CAllier<sarah_callier at yahoo.com>wrote: > What is your openion on the sedation of combative patients? I am involved> in a protocal commitie for EMS, We are looking at establishing protocalsto> allow the sedation of combative patients. Pt's that would fit into the> catagory for this treatment would be Psychiatric patientswho are violentand> pose a threat to themselves to the Police and to EMS providers. We willhave> strict guidelines for the administration of the medications. We arelooking> at using Versed Ativan and possibly the use of Droperidol. We are also> looking at the possibility of sedation for RSI and for combative trauma> patients. Any openions on what is better?>>>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  --Forwarded Message Attachment--From: LNMolino at aol.comSubject: Re: trauma-list Digest, Vol 62, Issue 5Date: Fri, 8 Aug 2008 04:36:54 +0000To: trauma-list at trauma.orgIt does Ross hence why the rest of you all consider us arrogant Americans.  LNM from Baku, Azerbaijan ------Original Message------From: Dr Ross HofmeyrSender: trauma-list-bounces at trauma.orgTo: 'Trauma &amp; Critical Care mailing list'ReplyTo: Trauma &amp; Critical Care mailing listSent: Aug 8, 2008 01:59Subject: RE: trauma-list Digest, Vol 62, Issue 5   > >> > Did you enter your address in Antarctica?:-)> > Tom Riley> -- Doesn't make a difference - according to _that_ particular interface theworld consists of two parts - the US and OutsideTheUS. --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  Sent via BlackBerry by AT&T --Forwarded Message Attachment--From: gamalejaimi at hotmail.comSubject: RE: Sedation for combative patientsDate: Fri, 8 Aug 2008 10:44:37 +0200To: trauma-list at trauma.org It is interesting and some time mandatory for such patients. small doses of combined ketamine and propofol may be beneficial ----------------------------------------> Date: Thu, 7 Aug 2008 14:39:35 -0700> From: sarah_callier at yahoo.com> Subject: Sedation for combative patients> To: trauma-list at trauma.org> > What is your openion on the sedation of combative patients? I am involved in a protocal commitie for EMS, We are looking at establishing protocals to allow the sedation of combative patients. Pt's that would fit into the catagory for this treatment would be Psychiatric patientswho are violent and pose a threat to themselves to the Police and to EMS providers. We will have strict guidelines for the administration of the medications. We are looking at using Versed Ativan and possibly the use of Droperidol. We are also looking at the possibility of sedation for RSI and for combative trauma patients. Any openions on what is better?> > >       > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/ _________________________________________________________________اتصل بالأصدقاء باستخدام اتصال كمبيوتر إلى كمبيوتر -- مجانًاhttp://get.live.com/messenger/overview--Forwarded Message Attachment--From: drtanmoy at gmail.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 14:45:39 +0530To: trauma-list at trauma.orgYou could try Clonidine or Dexmedetomidine for sedation of traumatizedpatients who are combative. 2008/8/8 gamal ejaimi <gamalejaimi at hotmail.com> >> It is interesting and some time mandatory for such patients. small doses of> combined ketamine and propofol may be beneficial>> ----------------------------------------> > Date: Thu, 7 Aug 2008 14:39:35 -0700> > From: sarah_callier at yahoo.com> > Subject: Sedation for combative patients> > To: trauma-list at trauma.org> >> > What is your openion on the sedation of combative patients? I am involved> in a protocal commitie for EMS, We are looking at establishing protocals to> allow the sedation of combative patients. Pt's that would fit into the> catagory for this treatment would be Psychiatric patientswho are violent and> pose a threat to themselves to the Police and to EMS providers. We will have> strict guidelines for the administration of the medications. We are looking> at using Versed Ativan and possibly the use of Droperidol. We are also> looking at the possibility of sedation for RSI and for combative trauma> patients. Any openions on what is better?> >> >> >> > --> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > http://www.trauma.org/index.php?/community/>> _________________________________________________________________> اتصل بالأصدقاء باستخدام اتصال كمبيوتر إلى كمبيوتر -- مجانًا> http://get.live.com/messenger/overview> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>   -- Dr. Tanmoy Das,MDSenior Consultant & Head,Department of Anesthesiology, Perioperative Medicine & Pain,Apollo Gleneagles Hospitals, Kolkata. India--Forwarded Message Attachment--From: LNMolino at aol.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 09:23:36 +0000To: trauma-list at trauma.orgI had to smile and recall a semi joke once stated by an instructor who referred to "BLS sedation" he made the comment that it came in two doses D and E both generally green (note 15 years ago) LNM from Baku, Azerbaijan Sent via BlackBerry by AT&T -----Original Message-----From: "Tanmoy Das" <drtanmoy at gmail.com> Date: Fri, 8 Aug 2008 14:45:39 To: Trauma &amp, Critical Care mailing list<trauma-list at trauma.org>Subject: Re: Sedation for combative patients  You could try Clonidine or Dexmedetomidine for sedation of traumatizedpatients who are combative. 2008/8/8 gamal ejaimi <gamalejaimi at hotmail.com> >> It is interesting and some time mandatory for such patients. small doses of> combined ketamine and propofol may be beneficial>> ----------------------------------------> > Date: Thu, 7 Aug 2008 14:39:35 -0700> > From: sarah_callier at yahoo.com> > Subject: Sedation for combative patients> > To: trauma-list at trauma.org> >> > What is your openion on the sedation of combative patients? I am involved> in a protocal commitie for EMS, We are looking at establishing protocals to> allow the sedation of combative patients. Pt's that would fit into the> catagory for this treatment would be Psychiatric patientswho are violent and> pose a threat to themselves to the Police and to EMS providers. We will have> strict guidelines for the administration of the medications. We are looking> at using Versed Ativan and possibly the use of Droperidol. We are also> looking at the possibility of sedation for RSI and for combative trauma> patients. Any openions on what is better?> >> >> >> > --> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > http://www.trauma.org/index.php?/community/>> _________________________________________________________________> اتصل بالأصدقاء باستخدام اتصال كمبيوتر إلى كمبيوتر -- مجانًا> http://get.live.com/messenger/overview> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>   -- Dr. Tanmoy Das,MDSenior Consultant & Head,Department of Anesthesiology, Perioperative Medicine & Pain,Apollo Gleneagles Hospitals, Kolkata. India--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/
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