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Wed Aug 13 21:59:29 BST 2008

There is no indication for administering ketamine and propofol together.
Ever. The treatment for inadequate ketamine dosage is more ketamine.

There is a considerable case for anaesthetising and intubating a patient who
is violent. If secondary to head injury you are preventing a potentially
catastrophic rise in intracranial pressure, and in the case of drug
intoxication you are protecting the airway. Sedation should only be
considered in the case of metabolic (such as thyroid storm) or untainted
psychosis. In the old days we gave chlorpromazine iv, now frowned on, and
lorazepam 4mg iv repeated to effect is preferred. If you can only get im in,
remember that midazolam is water soluble and thus can be given im, but be
prepared to wait a while.

Best Wishes,

BFM. 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of gamal ejaimi
Sent: 08 August 2008 09:45
To: Trauma &amp; Critical Care mailing list
Subject: RE: Sedation for combative patients

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?
> 
> 
>       
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Sedation for combative patients