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

Amy Hildreth amy at hildrethus.com
Mon Aug 18 19:34:11 BST 2008


Rowley,

Thanks.  We are hoping to get a larger, perhaps multicenter trial going.

Amy


On 8/18/08 9:55 AM, "Blueflightmedic" <trauma at emergencyunit.com> wrote:

> 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 &amp; 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 μg, 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. 27.8μg/dL,
> p<0.05). Change in serum cortisol between baseline and postintubation levels
> was different (-12.8 ± 9.6 μg/dL vs 1.1 ± 7.6 μg/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 :
> 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/ 
>> _________________________________________________________________???? 
>> ????????? ???????? ????? ??????? ??? ??????? -- 
>> ??????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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>> 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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> TRAUMA.ORG> To 
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>> _________________________________________________________________
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