RE: Sedation vs. sedation/paralysis

["Tom Waters" <tom@tomwaters.net>]

John-
Our RSI sequence is Etomidate 20mg Sux 100mg,then continued paralysis
with Vec 5 or 10mg boluses, accompanied by Versed 2-5mg, and if this is
a burn patient, for example, an analgesic of choice as well. (all
dosages weight-adjusted this is the starting point for routine adult pt.
Lido and Atropine are there as well, when appropriate)
 Once put down, pt's will remain paralyzed as well as sedated.  If done
in the field or referring hosptial, we will sometimes not give the very
last dose of vec so that upon landing, the Neuro team may get a better
idea of things, but we DO NOT hold paralysis/sedation merely so the pt.
isn't snowed and neuro can't eval.  Our head Neuro guy (no pun intended)
is one of the foremost in the country, and is very cool, understanding
the need for STABLE and SAFE over anything else with us in transport.
This being said, if the person is paralyzed due to the injury or
something, he/she may not be continually p-lyzed, but I can't remember
one in the last 6 months.

Although more convienent, and I really prefer it, nobody 'round here
likes the vec drip, they prefer repeated boluses.  But, that is a good
way to do your sustained, over that long flight.

Etomidate is wonderful, doesn't have and significant hemo effects to
speak of, has rapid onset and short-lived.  We really like it.

Good Luck, and say HI to Martha, and Pat and Mark and Will and Larry.  I
was with all of them when we had Roswell.  Kristy Too, we bump into each
other all the time!
I was just at your base visiting, you must have been off.

Tom Waters
NREMTP / CCEMTP / Flight Paramedic
Wyoming Medical Center / Life Flight
Casper, WY 1-800-442-2222



--Original Message-----
From: flightmed-admin@flightweb.com
[mailto:flightmed-admin@flightweb.com] On Behalf Of JSRN85@aol.com
Sent: Thursday, October 03, 2002 9:24
To: flightmed@flightweb.com
Subject: Sedation vs. sedation/paralysis


The flight srvice I work for is in the process of our yearly protocol
revisions.  Several questions have been brought up regarding the use of
sedation and paralysis of intubated patients.

I would like to find out if other services rotuinely use paralytics on
all intubated pt.s, along with sedation, or is sedation alone enough if
the pt. is not "fighting" the ventilator. 
Also, we are looking at adding Etomidate to our protocols, in addition
to the Versed/Mivacron we use presently.  If any other services are
using Etomidate, what are some of the pros/cons of this drug.

Thank you very much,
John Smith, RN
AeroCare
Lubbock, Tx.

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