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

Blueflightmedic trauma at emergencyunit.com
Wed Aug 13 22:04:44 BST 2008


There is ample evidence that even a single shot of etomidate increases
mortality in trauma. It is absolutely contraindicated.

Best Wishes,

Rowley. 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Timothy Craig Hardcastle
Sent: 11 August 2008 07:00
To: Trauma & Critical Care mailing list
Subject: RE: trauma-list Digest, Vol 62, Issue 7 - sedation and NICE
guidance.


Adrian

Well stated. Literature, if anything, is currently anti-RSI / in field
intubation anyhow, despite the often fairly substantial methodological flaws
in some of the "RCT" studies to date. One needs to balance RISK (often a
long-term issue) versus BENEFIT (right now!) to the patient and in the light
of the available skillset of the provider.

Personnally, in the TRAUMA subset, Etomidate and Sux with ongoing sedation
provided by either Midaz or Loraz WITHOUT muscle relaxation after induction
and successful intubation is the best INITIAL treatment.

The Etomidate and immune suppression has ONLY been shown to be of mortality
risk in the SEPTIC shock subgroup, with the largest study in TRAUMA (Cryer
et al) confounded by the head injury effects on the brain per se.

Just my 2c

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care Deputy
director: Trauma Unit and Trauma ICU Inkosi Albert Luthuli Central Hospital
/ UKZN 800 Bellair Road Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Adrian Marsh
Sent: 10 August 2008 23:13
To: trauma-list at trauma.org
Subject: RE: trauma-list Digest, Vol 62, Issue 7 - sedation and NICE
guidance.

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
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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
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-0400To: trauma-list at trauma.org_Surgeon's  Guidebook to the Horrors of
Battle - Book News - Entertainment -  Military.com_
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017 ) --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:>
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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:>
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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>
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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:>
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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:>
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_________________________________________________________________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=aolaut00050000000
017 )--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=aolaut00050000000
017 )--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
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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
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