Etomidate and Trauma

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To the etomidate folks:

I feel that etomidate has no real use in trauma. My reasons are:

1) Unpredictable myoclonic/hebiphrenic/catatonic reactions which can result in airway compromise or lack of patient control 
2) Adrenocortical suppression (and although it is alleged, I use the Cheney 1% rule) 
3) Expense (not yet an issue in the US, but if ObamaCare takes hold, budget-limited care...) 
4) Ease of administration (40 mg in 20 cc solution in a glass ampule? Give me a break.) 
4) Ketamine is the best brain eraser for the trauma victim, hands down. 

If I am to manage a trauma victim's airway in the ED, I do so in the following way:

First, I shut off the frontal lobe with ketamine. This is the kindest thing I can do. 
Ketamine does not affect the brain stem (blood pressure, respiration), and it renders mammals perceptually decerebrate (dissociative anesthetic). Next, I wage a receptor war: 
a) an Opiod for mu, kappa, et. al. receptors: 1 - 4 mg hydromorph (always treat pain) 
b) a GABA drug: 1 - 4 mg lorazepam (to treat anxiety, sedate, prevent seizures, provide muscle relaxaion, interject amnesia)  
c) an H1 blocker: 25 - 50 mg`diphenhydramine (to mitigate any histamine-releasing reaction) 
d) an H2 blocker: 20 mg famotidine (to prevent me from getting a Curling's or Cushing's ulcer) 
e) a neuromuscular blocker: 10 - 20 mg vecuronium (if necessary, depending upon the situation). 

If I am not worried about hypovolemia, then I occasionally use propofol in the place of  ketamine. 

After that (if the night is good), they should be the anesthetist's problem....

Come on - argue with me. I need stimulation.

DB

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