Flightmed archive for November-2003
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Flightmed archive for November-2003

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Hi Dave,
With our service in Arizona we may use Diprivan on occasion with 
interfacility transfers of relative short duration.  We do not carry this drug in our 
arsenal but can utilize/ titrate it after initiated by a sending facility.  It is 
an excellent drug for sedation when used in the clinical, controlled setting 
but, there can be profound hypotention as you know, when used in the trauma/ 
uncontrolled setting.  As with its use in head injured patients, if we can 
maintain a cerebral perfusion pressure of at least 600 torr, which is very 
difficult to measure in the field setting, it is a relatively safe drug to infuse.  
With hypotention however, there also can be a rapid drop in perfusion pressure 
which will increase the oncotic pressure of the tissues thus allowing fluid to 
collect in the surrounding cerebral tissues (not good in a HI patient).  

Propofol in the clinical setting appears to most nurses to be a very safe, 
easy drug to titrate and for the most part they are correct.  However, the 
untoward effects of the drug linked in conjunction with the pressure changes do to 
altitude/ pressurization, there can be very quickly ensuing, negative 
consequences with its use in the field or in the aircraft.  We do not carry or use 
this medication in our company.

Michael Klopp RN
Native Air Services, Inc.
Mesa, Arizona
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