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Mon Aug 18 12:03:54 BST 2008

Sure,
no problem I understand.

So, the ample evidence that a single shot of etomidate increases mortality
in trauma is?

This is a theoretical issue for me, etomidate is not available in my
country.

All the best,

Paul

On Mon, Aug 18, 2008 at 5:53 AM, Blueflightmedic
<trauma at emergencyunit.com>wrote:

> 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
> >
> > _________________________________________________________________
> > Win a voice over part with Kung Fu Panda & Live Search   and   100's of
> > Kung
> > Fu Panda prizes to win with Live Search
> > http://clk.atdmt.com/UKM/go/107571439/direct/01/
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