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Sun Aug 17 22:53:15 BST 2008

The point of this article is that you should use it as a springboard; the
reason I posted it was that it was recent and referred to issues with the
agent. I have commented back to Tim:

"Yes, I know. However, neither you nor I know which group of patients will
go on to develop sepsis, nor do we know whether suppression of the adrenals
(which we DO know happens) predisposes patients to sepsis. Single bolus
etomidate is now known to be dangerous as is infusion. When known safer
alternatives like ketamine and thiopentone are around I would rather not
take the risk."

Best Wishes,

Rowley. 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Paul Bailey
Sent: 16 August 2008 14:14
To: Trauma &amp, Critical Care mailing list
Subject: Re: trauma-list Digest, Vol 62, Issue 12

The quoted article is focussed on the use of steroids and etomidate in
sepsis.  In fact, if you search for the word "trauma" in the article, you
don't get a hit in the text of the article itself, but do hit reference 12,
an article from 1984.

The article concludes with the following statement:

"In the meantime, we need to forget Pearl Harbor and think twice before
using etomidate in the septic patient"

There may well be ample evidence out there that a single dose of etomidate
increases mortality in trauma, but I'm not sure this article addresses that
issue very well.

All the best,

Paul

ps if anyone would like the full text of the article, I'd be happy to
forward it to you.

On Thu, Aug 14, 2008 at 2:14 PM, Blueflightmedic
<trauma at emergencyunit.com>wrote:

> Good recent article in the EMJ from Bernard Foex and Hamish Thomson:
>
>
> http://emj.bmj.com/cgi/content/extract/25/8/469?maxtoshow=&HITS=10&hit
> s=10&R
>
> ESULTFORMAT=&fulltext=etomidate&andorexactfulltext=and&searchid=1&FIRS
> TINDEX
> =0&sortspec=relevance&resourcetype=HWCIT
>
> I apologise for the huge URL.
>
> Best Wishes,
>
> Rowley.
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto: 
> trauma-list-bounces at trauma.org] On Behalf Of Dominik Krzanicki
> Sent: 14 August 2008 12:38
> To: trauma-list at trauma.org
> Subject: RE: trauma-list Digest, Vol 62, Issue 12
>
>
>
>
>
> Date: Wed, 13 Aug 2008 22:04:44 +0100From: "Blueflightmedic"
> <trauma at emergencyunit.com>Subject: RE: trauma-list Digest, Vol 62, 
> Issue 7
> -
> sedation and NICE       guidance.To: "'Trauma &amp; Critical Care mailing
>  list'"  <trauma-list at trauma.org>Message-ID:
> <000201c8fd88$3798f5d0$0901a8c0 at vaio>Content-Type: text/plain;
> charset="windows-1256" There is ample evidence that even a single shot of
> etomidate increasesmortality in trauma. It is absolutely contraindicated.
I
> can see the evidence that single dose etomidate has an increased mortlity
> rate in septic patients - unless seondary steroid supplementation is
> administered. Continuous infusion is also pretty clear...not sure if I can
> see the overwhelming evidence for mortality following a single shot in
> trauma - could you expand on that please?
> Dom Krzanicki Dr Dominik Krzanicki
> MBChB(Hons), MRCS (Eng), DIMC (RCSEd)
> StR Anaesthetics and Intensive Care
> Tel: +44 (0) 7801 118790
> E-mail: dominikkrzanicki at hotmail.com
>
> _________________________________________________________________
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