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trauma-list Digest, Vol 62, Issue 7 - etomidate and thetrauma patient

dr.tchardcastle at absamail.co.za dr.tchardcastle at absamail.co.za
Mon Aug 18 19:01:27 BST 2008


Rowley and Amy

Longer ICU stays and so is not increased mortality! Indeed this is what
has been shown before, with no increased mortality for the trauma group

Amy - was the mortality higher and by how much?

Nice study though.

Tim Hardcastle
South Africa

> Amy, that is a very interesting perspective and congratulations for
> starting
> to produce some hard data. I take it that you are using this as a pilot to
> get a properly powered study running?
>
> Best Wishes,
>
> Rowley.
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Amy Hildreth
> Sent: 18 August 2008 01:56
> To: Trauma & Critical Care mailing list
> Subject: Re: trauma-list Digest, Vol 62, Issue 7 - etomidate and thetrauma
> patient
>
>
> All-
>
> Sorry to enter the conversation so late, but there is some new prospective
> data regarding etomidate in the trauma patient that might be of interest.
> See abstract below (in press, J Trauma).  Our study was obviously not
> powered to detect mortality differences, but I think the results are
> interesting, nevertheless.
>
> Amy Hildreth
>
> Amy Hildreth, M.D.
> Assistant Professor
> Department of Surgery
> Wake Forest University Baptist Medical Center
>
>
> Adrenal Suppression Following a Single Dose of Etomidate For Rapid
> Sequence
> Induction: A Prospective Randomized Study
> Amy Hildreth, M.D.; Vicente A Mejia, M.D.; Robert A Maxwell, M.D.; Philip
> W
> Smith, M.D.; Benjamin W Dart, M.D.; Donald E Barker, M.D.
>
> Introduction: The administration of etomidate for rapid sequence induction
> (RSI) has been linked to subsequent adrenocortical insufficiency in
> non-trauma patients. However, etomidate- related adrenocortical
> insufficiency has not been well studied in the trauma population.
> Purpose: We performed a prospective, randomized, controlled study to
> assess
> the effect of one dose of etomidate for RSI on adrenal function and its
> clinical significance during and after resuscitation in trauma patients.
> Methods: Adult trauma patients admitted to our Level I trauma center
> requiring RSI were randomized to receive etomidate 0.3mg/kg and
> succinylcholine 1mg/kg (E group) or fentanyl 100 ìg, midazolam 5mg, and
> succinylcholine 1mg/kg (FM group) for induction. A baseline serum cortisol
> level was drawn prior to RSI. Four to six hours after RSI a postintubation
> serum cortisol level was drawn. An ACTH stimulation test (CST) was
> performed.
> Results: 30 patients were enrolled: 18 E group patients and 12 FM group
> patients. No statistical difference was detected between the two groups
> with
> respect to age, injury severity score (ISS), and baseline serum cortisol.
> Mean serum cortisol levels were significantly lower in E group patients
> than
> in FM group patients four to six hours after intubation (18.2 vs.
> 27.8ìg/dL,
> p<0.05). Change in serum cortisol between baseline and postintubation
> levels
> was different (-12.8 ± 9.6 ìg/dL vs 1.1 ± 7.6 ìg/dL, p<0.01). Patients in
> the E group had an average increase in cortisol following ACTH
> administration of 4.2 ± 4.9 mg/dL vs. 11.2 ± 6.1 mg/dL in the FM group, p
> <
> 0.001. Patients in the E group required longer ICU lengths of stay (mean
> 6.3
> vs. 1.5 days, p<0.05), more ventilator days (mean 28 vs. 17 days, p<0.01),
> and longer hospital lengths of stay (mean 11.6 vs. 6.4 days, p<0.01).
> Conclusions: The use of etomidate for RSI in trauma patients led to
> chemical
> evidence of adrenocortical insufficiency and may have contributed to
> increased hospital and ICU lengths of stay and increased ventilator days.
> Further studies should be considered to evaluate the safety profile of
> this
> drug in trauma patients.
>
>
>
>
>
>
> On 8/11/08 1:59 AM, "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za>
> wrote:
>
>> 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 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/
>> _________________________________________________________________????
>> ????????? ???????? ????? ??????? ??? ??????? --
>> ??????http://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
>> -0700> > combative
>> patients> > To: trauma-list at trauma.org> >> > What is your openion on
>> patients> > 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/>>
>> _________________________________________________________________> ????
>> ????????? ???????? ????? ??????? ??? ??????? -- ??????>
>> 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/>>
>> ____________________ _____________________________________________> ????
>> ????????? ???????? ????? ??????? ??? ??????? -- ??????>
>> 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
> -h
>> orrors-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=aolaut00050000000
> 01
>> 7 ) --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
>> Message-----> 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
>> involved>>> 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
>> Message-----> 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.
>> and>>> We>>>
>> will have>>> strict guidelines for the administration of the
>> medications. We
>> are>>> looking>>> at using Versed Ativan and possibly the use of
>> are>>> looking>>> Droperidol.
>> We are also>> looking at the possibility of sedation for RSI and for
>> combative>>> trauma>>> patients. Any openions on what is
>> combative>>> trauma>>> 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
>> Message-----> 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.
>> and>>> We>>>
>> will have>>> strict guidelines for the administration of the
>> medications. We
>> are>>> looking>>> at using Versed Ativan and possibly the use of
>> are>>> looking>>> Droperidol.
>> We are also>> looking at the possibility of sedation for RSI and for
>> combative>>> trauma>>> patients. Any openions on what is
>> combative>>> trauma>>> 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:
>> Message-----> 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
>> refrigerated> 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
>> involved> > in> > driven
>> the> pick-up into> > the ditch at a slow speed..no damage to the
>> 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 :
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>> _________________________________________________________________????
>> ????????? ???????? ????? ??????? ??? ??????? --
>> ??????http://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
> -h
>> orrors-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
> 01
>> 7 )--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
> -h
>> orrors-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
> 01
>> 7 )--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
>> Message-----> 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.
>> and>>> We>>>
>> will have>>> strict guidelines for the administration of the
>> medications. We
>> are>>> looking>>> at using Versed Ativan and possibly the use of
>> are>>> looking>>> Droperidol.
>> We are also>> looking at the possibility of sedation for RSI and for
>> combative>>> trauma>>> patients. Any openions on what is
>> combative>>> trauma>>> better?>>>>>>>> -->>
>> trauma-list : TRAUMA.ORG>> To change your settings or unsubscribe
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>> _________________________________________________________________
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