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trauma-list Digest, Vol 62, Issue 7 - sedation and NICE guidance.

Adrian Marsh adrianmarsh99 at hotmail.com
Sun Aug 10 22:12:48 BST 2008


It depends on the situation. For the agitated patient (psychotic/ confused) in the emergency department, once reversible causes e.g. hypoxia, hypoglycaemia etc, have been excluded then everywhere  I have worked follows the NICE guidelines (CG25). This could be applied in the pre-hospital world. 
Sedation for extrication is a different kettle of fish, it appears to depend on personal choice/experience - what is safe for one person is not for others. It also depends if it is purely for the 2 minutes to extricate or if you are aiming to RSI post extraction. 
Sedation for RSI is dependant again on personal choice - the debate goes on in the literature (etomodate and suppression of the immune system, increase in deaths with thiopentone, ketamine and blood pressure in head injuries).
Maintence post RSI is either with boluses of ketamine or propofol or midazolam and morphine. I can not find a study which advocates one or the other. The user must be experienced in which ever one is used. Without a syringe driver propofol ongoing sedation is bit of an art-form in the paralysed patient!Dr Adrian Marsh
A&E SpR.
BASICS



From: trauma-list-request at trauma.orgSubject: trauma-list Digest, Vol 62, Issue 7To: trauma-list at trauma.orgDate: Sat, 9 Aug 2008 12:01:01 +0100Send 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-listor, 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 specificthan "Re: Contents of trauma-list digest..."--Forwarded Message Attachment--From: hellaby at hotmail.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 11:25:08 +0000To: trauma-list at trauma.org 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), RODPATACC InstructorCheshire Fire Service Trauma InstructorNorth 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:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://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 o2satsthoug h.... -----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_call ier 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:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://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:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://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:> h http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://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:> > hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://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:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>   -- Dr. Tanmoy Das,MDSenior Consultant & Head,Department of Anes thesiology, 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:> > hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://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:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://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:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/_________________________________________________________________Make a mini you on Windows Live Messenger!http://clk.atdmt.com/UKM/go/107571437/direct/01/--Forwarded Message Attachment--From: msmaltini345 at aol.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 08:32:49 -0400To: trauma-list at trauma.orgdo you carry versed?  -----Original Message-----From: Jules <jkaymdc at aim.com>To: Trauma &amp, Critical Care mailing list <trauma-list at trauma.org>Sent: Thu, 7 Aug 2008 6:24 pmSubject: 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 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:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/  --Forwarded Message Attachment--From: CLAUDIAK1 at aol.comSubject: Check out Surgeon's Guidebook to the Horrors of Battle - Book News - EntertaiDate: Fri, 8 Aug 2008 08:54:41 -0400To: trauma-list at trauma.org_Surgeon's  Guidebook to the Horrors of Battle - Book News - Entertainment -  Military.com_ (http://www.military.com/entertainment/books/book-news/surgeons-guidebook-to-horrors-of-battle?ESRC=soldiertech.nl)   >From another site Claudia Kenworthy MDMedical Concepts  Ltd. "Ability is what you're capable of doing.  Motivation determines what you do. Attitude determines how well you do  it."   **************Looking for a car that's sporty, fun and fits in your budget? Read reviews on AOL Autos.      (http://autos.aol.com/cars-BMW-128-2008/expert-review?ncid=aolaut00050000000017 ) --Forwarded Message Attachment--From: jkaymdc at aim.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 07:54:54 -0500To: trauma-list at trauma.orgUnfortunately, no, although it is one I'm pushing for. However,administration and onset of action would still be difficult and fairly longin this setting. Excited delirium is becoming (or maybe always has been) oneof the biggest scene safety issues for medics, IMO...with the things peopleare lacing their recreational drugs with...IS there a chemical restraintthat will be immediately effective? How can it be administered safely...bothfor the patient and the medic? Jules On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote: > do you carry versed?>>> -----Original Message-----> From: Jules <jkaymdc at aim.com>> To: Trauma &amp, Critical Care mailing list <trauma-list at trauma.org>> Sent: Thu, 7 Aug 2008 6:24 pm> Subject: Re: Sedation for combative patients>>>> i would also be interested in this information. A week ago I was involved> in> a call for a "trauma" although the individual had driven the pick-up into> the ditch at a slow speed..no damage to the vehicle. However, the person> was> showing signs of "meth" use (possible OD), had experienced a seizure and> was> at this time extremely violent, swinging at me and LE each time we> attempted> to calm him.>> The only medication I had available was Valium...IM of course, which was> like spitting in the wind.>> In the end he was tased 5 times, had received a total of 5 valium IM, 5> Valium 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:>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>>>>  --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/> --Forwarded Message Attachment--From: LNMolino at aol.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 13:10:35 +0000To: trauma-list at trauma.orgBased on my research for the article I did for Fire Engineering Magizine appearing in the August issue (shameless plug over) I'd say that in the case of drug affected/Excited delirium etc Patients I'd suggest that a fast acting drug based solution is not likely to be effective.  When you have patients taking multiple hits from a Tazer and not blinking their brains are pretty disconnected at that point.  LNM from Baku, Azerbaijan Sent via BlackBerry by AT&T -----Original Message-----From: Jules <jkaymdc at aim.com> Date: Fri, 8 Aug 2008 07:54:54 To: Trauma &amp, Critical Care mailing list<trauma-list at trauma.org>Subject: Re: Sedation for combative patients  Unfortunately, no, although it is one I'm pushing for. However,administration and onset of action would still be difficult and fairly longin this setting. Excited delirium is becoming (or maybe always has been) oneof the biggest scene safety issues for medics, IMO...with the things peopleare lacing their recreational drugs with...IS there a chemical restraintthat will be immediately effective? How can it be administered safely...bothfor the patient and the medic? Jules On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote: > do you carry versed?>>> -----Original Message-----> From: Jules <jkaymdc at aim.com>> To: Trauma &amp, Critical Care mailing list <trauma-list at trauma.org>> Sent: Thu, 7 Aug 2008 6:24 pm> Subject: Re: Sedation for combative patients>>>> i would also be interested in this information. A week ago I was involved> in> a call for a "trauma" although the individual had driven the pick-up into> the ditch at a slow speed..no damage to the vehicle. However, the person> was> showing signs of "meth" use (possible OD), had experienced a seizure and> was> at this time extremely violent, swinging at me and LE each time we> attempted> to calm him.>> The only medication I had available was Valium...IM of course, which was> like spitting in the wind.>> In the end he was tased 5 times, had received a total of 5 valium IM, 5> Valium 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:>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>>>>  --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/--Forwarded Message Attachment--From: sarah_callier at yahoo.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 07:34:55 -0700To: trauma-list at trauma.orgVersed is the main medication that i am trying to get to carry in our service. We have to present several medications to the Medical director. I think through my research that this would be a good medication but the administrators think ativan is better. The problem with ativan is that it needs to be refrigerated and we do not at this time have our trucks equipped for this.  --- On Fri, 8/8/08, Jules <jkaymdc at aim.com> wrote: From: Jules <jkaymdc at aim.com>Subject: Re: Sedation for combative patientsTo: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>Date: Friday, August 8, 2008, 7:54 AM Unfortunately, no, although it is one I'm pushing for. However,administration and onset of action would still be difficult and fairly longin this setting. Excited delirium is becoming (or maybe always has been) oneof the biggest scene safety issues for medics, IMO...with the things peopleare lacing their recreational drugs with...IS there a chemical restraintthat will be immediately effective? How can it be administered safely...bothfor the patient and the medic? Jules On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote: > do you carry versed?>>> -----Original Message-----> From: Jules <jkaymdc at aim.com>> To: Trauma &amp, Critical Care mailing list<trauma-list at trauma.org>> Sent: Thu, 7 Aug 2008 6:24 pm> Subject: Re: Sedation for combative patients>>>> i would also be interested in this information. A week ago I was involved> in> a call for a "trauma" although the individual had driven thepick-up into> the ditch at a slow speed..no damage to the vehicle. However, the person> was> showing signs of "meth" use (possible OD), had experienced aseizure and> was> at this time extremely violent, swinging at me and LE each time we> attempted> to calm him.>> The only medication I had available was Valium...IM of course, which was> like spitting in the wind.>> In the end he was tased 5 times, had received a total of 5 valium IM, 5> Valium IV, 4 Ativan IV, and 5 Haldol IM (between pre hospital andhospital)> 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 intothe>> 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:>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>>>>  --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/         --Forwarded Message Attachment--From: msmaltini345 at aol.comSubject: Re: Sedation for combative patientsDate: Fri, 8 Aug 2008 14:09:23 -0400To: trauma-list at trauma.orgwe have found Versed to work well for preintubation sedation and post intubation compliance.  -----Original Message-----From: Sarah CAllier <sarah_callier at yahoo.com>To: Trauma & Critical Care mailing list <trauma-list at trauma.org>Sent: Fri, 8 Aug 2008 10:34 amSubject: Re: Sedation for combative patients   Versed is the main medication that i am trying to get to carry in our service.We have to present several medications to the Medical director. I think throughmy research that this would be a good medication but the administrators thinkativan is better. The problem with ativan is that it needs to be refrigeratedand we do not at this time have our trucks equipped for this. --- On Fri, 8/8/08, Jules <jkaymdc at aim.com> wrote: From: Jules <jkaymdc at aim.com>Subject: Re: Sedation for combative patientsTo: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>Date: Friday, August 8, 2008, 7:54 AM Unfortunately, no, although it is one I'm pushing for. However,administration and onset of action would still be difficult and fairly longin this setting. Excited delirium is becoming (or maybe always has been) oneof the biggest scene safety issues for medics, IMO...with the things peopleare lacing their recreational drugs with...IS there a chemical restraintthat will be immediately effective? How can it be administered safely...bothfor the patient and the medic? Jules On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote: > do you carry versed?>>> -----Original Message-----> From: Jules <jkaymdc at aim.com>> To: Trauma &amp, Critical Care mailing list<trauma-list at trauma.org>> Sent: Thu, 7 Aug 2008 6:24 pm> Subject: Re: Sedation for combative patients>>>> i would also be interested in this information. A week ago I was involved> in> a call for a "trauma" although the individual had driven thepick-up into> the ditch at a slow speed..no damage to the vehicle. However, the person> was> showing signs of "meth" use (possible OD), had experienced aseizure and> was> at this time extremely violent, swinging at me and LE each time we> attempted> to calm him.>> The only medication I had available was Valium...IM of course, which was> like spitting in the wind.>> In the end he was tased 5 times, had received a total of 5 valium IM, 5> Valium IV, 4 Ativan IV, and 5 Haldol IM (between pre hospital andhospital)> 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 intothe>> 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:>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>>>>  --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/    --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/  --Forwarded Message Attachment--From: medic0947969 at yahoo.comSubject: excited deliriumDate: Fri, 8 Aug 2008 12:15:48 -0700To: trauma-list at trauma.org I have actually been doing some research on this, and while I don't have anything publishable at this point, seems to be directly related to toxicology, all the coroners I have spoken with on the subject or who has provided me data, have in common, that it is only listed as a contributing factor in the death, not the cause. Furthermore it appears at first glance there is always toxicology involved in these cases, and are very rare. I have also noticed that all of these are with persons interacting with law enforcement officials. I have also contacted zoologists and a DVMs, who cannot recall any nonhuman animal that can excite itself to death via sympathetic nervous response or other biochemical process. I would be extremely cautious about using this as justification for any protocol or sedation criteria. I ask the forgiveness of the forum members as this is not trauma related, and will confine my comments on list to this message Mike --- On Fri, 8/8/08, Jules <jkaymdc at aim.com> wrote: From: Jules <jkaymdc at aim.com>Subject: Re: Sedation for combative patientsTo: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>Date: Friday, August 8, 2008, 8:54 AM Unfortunately, no, although it is one I'm pushing for. However,administration and onset of action would still be difficult and fairly longin this setting. Excited delirium is becoming (or maybe always has been) oneof the biggest scene safety issues for medics, IMO...with the things peopleare lacing their recreational drugs with...IS there a chemical restraintthat will be immediately effective? How can it be administered safely...bothfor the patient and the medic? Jules On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote: > do you carry versed?>>> -----Original Message-----> From: Jules <jkaymdc at aim.com>> To: Trauma &amp, Critical Care mailing list<trauma-list at trauma.org>> Sent: Thu, 7 Aug 2008 6:24 pm> Subject: Re: Sedation for combative patients>>>> i would also be interested in this information. A week ago I was involved> in> a call for a "trauma" although the individual had driven thepick-up into> the ditch at a slow speed..no damage to the vehicle. However, the person> was> showing signs of "meth" use (possible OD), had experienced aseizure and> was> at this time extremely violent, swinging at me and LE each time we> attempted> to calm him.>> The only medication I had available was Valium...IM of course, which was> like spitting in the wind.>> In the end he was tased 5 times, had received a total of 5 valium IM, 5> Valium IV, 4 Ativan IV, and 5 Haldol IM (between pre hospital andhospital)> 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 intothe>> 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:>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>>>>  --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/         --Forwarded Message Attachment--From: gamalejaimi at hotmail.comSubject: RE: Sedation for combative patientsDate: Fri, 8 Aug 2008 21:24:09 +0200To: trauma-list at trauma.org may if possible to give us more information about the dose and onset or optimum time for intubation. Just to catagorize the type of sedation-dgree   Dr. Gamal Ejaimi.Anaesthesiologist and Intensivist.             Gadarif University            Faculty of Medicine00249912323439gamalejaimi at hotmail.com ----------------------------------------> To: trauma-list at trauma.org> Subject: Re: Sedation for combative patients> Date: Fri, 8 Aug 2008 14:09:23 -0400> From: msmaltini345 at aol.com> > we have found Versed to work well for preintubation sedation and post > intubation compliance.> > > -----Original Message-----> From: Sarah CAllier <sarah_callier at yahoo.com>> To: Trauma & Critical Care mailing list <trauma-list at trauma.org>> Sent: Fri, 8 Aug 2008 10:34 am> Subject: Re: Sedation for combative patients> > > > Versed is the main medication that i am trying to get to carry in our > service.> We have to present several medications to the Medical director. I think > through> my research that this would be a good medication but the administrators > think> ativan is better. The problem with ativan is that it needs to be > refrigerated> and we do not at this time have our trucks equipped for this.> > --- On Fri, 8/8/08, Jules <jkaymdc at aim.com> wrote:> > From: Jules <jkaymdc at aim.com>> Subject: Re: Sedation for combative patients> To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>> Date: Friday, August 8, 2008, 7:54 AM> > Unfortunately, no, although it is one I'm pushing for. However,> administration and onset of action would still be difficult and fairly > long> in this setting. Excited delirium is becoming (or maybe always has > been) one> of the biggest scene safety issues for medics, IMO...with the things > people> are lacing their recreational drugs with...IS there a chemical restraint> that will be immediately effective? How can it be administered > safely...both> for the patient and the medic?> > Jules> > On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote:> > > do you carry versed?> >> >> > -----Original Message-----> > From: Jules <jkaymdc at aim.com>> > To: Trauma &amp, Critical Care mailing list> <trauma-list at trauma.org>> > Sent: Thu, 7 Aug 2008 6:24 pm> > Subject: Re: Sedation for combative patients> >> >> >> > i would also be interested in this information. A week ago I was > involved> > in> > a call for a "trauma" although the individual had driven the> pick-up into> > the ditch at a slow speed..no damage to the vehicle. However, the > person> > was> > showing signs of "meth" use (possible OD), had experienced a> seizure and> > was> > at this time extremely violent, swinging at me and LE each time we> > attempted> > to calm him.> >> > The only medication I had available was Valium...IM of course, which > was> > like spitting in the wind.> >> > In the end he was tased 5 times, had received a total of 5 valium IM, > 5> > Valium 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:> >> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/> >>> >>  --> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/> >> > --> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/> >> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/> > > > > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/ _________________________________________________________________اتصل بالأصدقاء باستخدام اتصال كمبيوتر إلى كمبيوتر -- مجانًاhttp://get.live.com/messenger/overview--Forwarded Message Attachment--From: jnpmesserole at mchsi.comSubject: RE: Check out Surgeon's Guidebook to the Horrors of Battle - Book News - EntertaiDate: Fri, 8 Aug 2008 14:50:39 -0500To: trauma-list at trauma.orgI've read the reviews - where do you go to order a copy?  Can't seem to findone.  Any help would be appreciated. JJMesserolePHTLS Affiliate Faculty -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On Behalf Of CLAUDIAK1 at aol.comSent: Friday, August 08, 2008 7:55 AMTo: trauma-list at trauma.orgSubject: Check out Surgeon's Guidebook to the Horrors of Battle - Book News- Entertai _Surgeon's  Guidebook to the Horrors of Battle - Book News - Entertainment - Military.com_ (http://www.military.com/entertainment/books/book-news/surgeons-guidebook-to-horrors-of-battle?ESRC=soldiertech.nl)   >From another site Claudia Kenworthy MDMedical Concepts  Ltd. "Ability is what you're capable of doing.  Motivation determines what youdo. Attitude determines how well you do  it."   **************Looking for a car that's sporty, fun and fits in your budget? Read reviews on AOL Autos.      (http://autos.aol.com/cars-BMW-128-2008/expert-review?ncid=aolaut00050000000017 )--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/  --Forwarded Message Attachment--From: nmcswai at tulane.eduSubject: RE: Check out Surgeon's Guidebook to the Horrors of Battle - BookNews - EntertaiDate: Fri, 8 Aug 2008 14:50:47 -0500To: trauma-list at trauma.orgGovernment Printing Office - $71 Norman Norman McSwain MDProfessor, Tulane School of MedicineTrauma Director, Charity Hospital Trauma Centernorman.mcswain at tulane.edu504 988 5111 -----Original Message-----From: trauma-list-bounces at trauma.org[mailto:trauma-list-bounces at trauma.org] On Behalf Of jeff n pat mSent: Friday, August 08, 2008 2:51 PMTo: 'Trauma &amp; Critical Care mailing list'Subject: RE: Check out Surgeon's Guidebook to the Horrors of Battle -BookNews - Entertai I've read the reviews - where do you go to order a copy?  Can't seem tofindone.  Any help would be appreciated. JJMesserolePHTLS Affiliate Faculty -----Original Message-----From: trauma-list-bounces at trauma.org[mailto:trauma-list-bounces at trauma.org]On Behalf Of CLAUDIAK1 at aol.comSent: Friday, August 08, 2008 7:55 AMTo: trauma-list at trauma.orgSubject: Check out Surgeon's Guidebook to the Horrors of Battle - BookNews- Entertai _Surgeon's  Guidebook to the Horrors of Battle - Book News -Entertainment - Military.com_ (http://www.military.com/entertainment/books/book-news/surgeons-guidebook-to-horrors-of-battle?ESRC=soldiertech.nl)   >From another site Claudia Kenworthy MDMedical Concepts  Ltd. "Ability is what you're capable of doing.  Motivation determines whatyoudo. Attitude determines how well you do  it."   **************Looking for a car that's sporty, fun and fits in yourbudget? Read reviews on AOL Autos.      (http://autos.aol.com/cars-BMW-128-2008/expert-review?ncid=aolaut00050000000017 )--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/ --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/ --Forwarded Message Attachment--From: LNMolino at aol.comSubject: Re: excited deliriumDate: Fri, 8 Aug 2008 20:59:00 +0000To: trauma-list at trauma.orgI think I saw one questionable citation on the diagnosis as a cause of death from Texas.  LNM from Baku, Azerbaijan Sent via BlackBerry by AT&T -----Original Message-----From: Mike Smertka <medic0947969 at yahoo.com> Date: Fri, 8 Aug 2008 12:15:48 To: Trauma & Critical Care mailing list<trauma-list at trauma.org>Subject: excited delirium   I have actually been doing some research on this, and while I don't have anything publishable at this point, seems to be directly related to toxicology, all the coroners I have spoken with on the subject or who has provided me data, have in common, that it is only listed as a contributing factor in the death, not the cause. Furthermore it appears at first glance there is always toxicology involved in these cases, and are very rare. I have also noticed that all of these are with persons interacting with law enforcement officials. I have also contacted zoologists and a DVMs, who cannot recall any nonhuman animal that can excite itself to death via sympathetic nervous response or other biochemical process. I would be extremely cautious about using this as justification for any protocol or sedation criteria. I ask the forgiveness of the forum members as this is not trauma related, and will confine my comments on list to this message Mike --- On Fri, 8/8/08, Jules <jkaymdc at aim.com> wrote: From: Jules <jkaymdc at aim.com>Subject: Re: Sedation for combative patientsTo: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>Date: Friday, August 8, 2008, 8:54 AM Unfortunately, no, although it is one I'm pushing for. However,administration and onset of action would still be difficult and fairly longin this setting. Excited delirium is becoming (or maybe always has been) oneof the biggest scene safety issues for medics, IMO...with the things peopleare lacing their recreational drugs with...IS there a chemical restraintthat will be immediately effective? How can it be administered safely...bothfor the patient and the medic? Jules On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote: > do you carry versed?>>> -----Original Message-----> From: Jules <jkaymdc at aim.com>> To: Trauma &amp, Critical Care mailing list<trauma-list at trauma.org>> Sent: Thu, 7 Aug 2008 6:24 pm> Subject: Re: Sedation for combative patients>>>> i would also be interested in this information. A week ago I was involved> in> a call for a "trauma" although the individual had driven thepick-up into> the ditch at a slow speed..no damage to the vehicle. However, the person> was> showing signs of "meth" use (possible OD), had experienced aseizure and> was> at this time extremely violent, swinging at me and LE each time we> attempted> to calm him.>> The only medication I had available was Valium...IM of course, which was> like spitting in the wind.>> In the end he was tased 5 times, had received a total of 5 valium IM, 5> Valium IV, 4 Ativan IV, and 5 Haldol IM (between pre hospital andhospital)> 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 intothe>> 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:>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>>>>  --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/         --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/
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