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

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Tim-

There were more deaths in the E group (2 patients in the E group vs. 0 in
the FM group, p=NS), but clearly the study would need more patients to
detect a real difference in mortality between the groups.

The full manuscript should be available in the Jtrauma next month.

Amy 


On 8/18/08 2:01 PM, "dr.tchardcastle at absamail.co.za"
<dr.tchardcastle at absamail.co.za> wrote:

> 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 &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 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 :
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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>
>>> 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
>>> visit:>>
>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2008-August/ttp://www.trauma.org/index.php?/community/>>>>  --> trauma-list :
>> TRAUMA.ORG>
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>>> 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
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>>> :
>>> 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/
>>> _________________________________________________________________
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>>> http://clk.atdmt.com/UKM/go/107571437/direct/01/
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>>> 
>> 
>> 
>> --
>> trauma-list : TRAUMA.ORG
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