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Real0ne -> RE: Kidnapping, chloroforming, knocking out...yum (9/18/2007 8:59:27 AM)
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quote:
ORIGINAL: MisPandora
quote:
ORIGINAL: Aswad
If the idea is to be fully aware but paralyzed, I haven't a clue right now, but will be looking into it.
While it is possible to do it, it's just not practical in the environment that we play in. Here's why.
There are drugs used for rapid sequence intubation that facilitate paralysis -- it's the induction of general (temporary) anesthesia for the purpose of putting a tube down one's throat. There are 4 pharmacologic components to it -- analgesia, muscle relaxation, amnesia/unconsciousness, and the blockade of autonomic reflex responses to stimuli
Seems a little late to try to tie the bag after leaving the cat out doesnt it?
Eduardo G. Marvez-Valls, James P. Killeen, Jorge Martinez, Charles Preston and Jerome Kochinski Louisiana State University, Emergency Medicine Residency Program, New Orleans, LA. ABSTRACT Objective: To review the complications and deviations of protocols for Rapid Sequence Intubation (RSI) performed at an urban inner city ED. Methods: A retrospective review of QA forms of all intubations where RSI was used during the period 2/96 to 12/98. Four different protocols were used: #1-Adult-Midazolam (Midz) 1mg/kg or Etomidate (Etom) 0.3mg/kg + Succinylcholine (Succ) 1-1.5mg/kg or Rocuronium (Roc) 0.6mg/kg; #2-Pediatric-Atropine 0.02 mg/kg + Etom 0.3mg/kg or Thiopental 4.0mg/kg + Succ 2.0mg/kg or Roc 0.6-1.0 mg/kg; #3-Adults with Increased Intracranial Pressure-Lidocaine 1.0mg/kg + Etom 0.3mg/kg or Midz 0.1mg/kg + Succ 1-1.5 mg/kg or Roc 0.6-1.2mg/kg; and #4-COPD/Asthma-Ketamine 1.0-2.0mg/kg or Midz 1.0mg/kg + Succ 1.0-1.5mg/kg or Roc 0.6-1.2mg/kg. All protocols required pre-oxygenation with 100% O2, 2 IV sites and use of the Sellick maneuver after administering the sedative. The main outcome measured was the number and type of RSI complications as well as deviations from protocols. Results: There were a total of 879 cases reviewed of which 54 cases(4%) (95% CI 0.03-0.05) were noted to have complications. The most common complication was desaturation (PSO2<90%) with 27 cases(2%), followed by cricothyrotomy 18 cases(1%), hypotension 6 cases(0.7%), hypertension 1 case(0.1%), and bradycardia 2 cases(0.1%). There were 274 cases(23%) (95% CI 0.020-0.026) in which a deviation from protocol was noted. These included appropriate withholding or substituting medications 199 cases(16%), dosage alterations 55 cases(5%) and procedural variance 20 cases(2%). No deaths were reported. Conclusion: We report a complication rate of 4% using RSI protocols and no reported deaths. Deviation from protocols were insignificant.
http://www.aemj.org/cgi/content/abstract/6/5/516-b
quote:
ORIGINAL: MisPandora
quote:
ORIGINAL: Notanaddict
I've read through this entire thread and no-one has mentioned ketamin.... A disassociative sedative that makes you hallucinate and makes it difficult to move (K-hole) ... You don.t want to OD on it, but OD'ing on alcohol is also bad bad bad...
Several of my posts were on drugs for rapid sequence intubation -- but not spelling them out specifically. K is one of the lesser used drugs in the cocktail (because of it's hallucinogenic properties.) I didn't spell out the drugs because I don't personally want to see people trying to seek it out and try it. Call that a little sense of responsibility, sry.
RAPID SEQUENCE INTUBATION
Indications:
1. Trauma patients with Glasgow Coma Scale of nine or less with gag reflex.
2. Trauma patients with significant facial trauma and poor airway control.
3. Closed head injury or major stroke with unconsciousness.
4. Burn patients with airway involvement and inevitable airway loss.
5. Respiratory exhaustion such as severe asthma, CHF or COPD with hypoxia.
6. Overdoses with altered mental status where loss of airway is inevitable.
Preparation:
1. Assess oropharynx and neck anatomy to anticipate difficult intubation. “Can I bag
this patient if I cannot intubate him?”
2. Administer 100% oxygen. Have bag-valve-mask at hand.
3. Apply three lead cardiac monitor, BP monitor, pulse oximeter.
4. Secure intravenous access.
5. Test ET tube and all equipment necessary for intubation.
6. Estimate patient’s weight, calculate drug dosages, and draw up into syringes.
Procedure:
1. Preoxygenate with 100% oxygen by non-rebreather mask for at least 3 full, deep
breaths. If ventilation is required, bag gently while cricoid pressue is applied.
Preoxygenate four minutes if situation allows.
2. Administer either midazolam OR etomidate.
a. Midazolam dose is 2 mg for the average size adult.
b. Etomidate dose is 0.3 mg/kg, about 20 mg for the average size adult.
c. If systolic pressure is 80-100 mmHg, utilize etomidate or decrease midazolam
dose.
3. Administer lidocaine 1.5 mg/kg to patients with head trauma or stroke.
4. Apply cricoid pressure and hold until patient has been intubated, balloon of ETT has
been inflated, position of tube tip has been assured, and ETT has been secured in
place.
5. Administer succinylcholine 1.5 mg/kg IVP (100 mg for average 70kg patient) and
wait for paralysis to occur.
6. Intubate. Discontinue attempt and ventilate with 100% O₂ if:
a. Thirty seconds has passed, and PO₂ falls below 91% or
b. Heart rate falls below 60.
7. When successfully intubated, confirm placement by
a. Bilateral breath sounds, and
b. Chest wall rise, and
c. Absense of gastric sounds, and
d. End tidal CO₂ measurement, and
e. Continued PO₂ readings in the high 90’s (if this is consistent with the
patient’s baseline)
8. A second qualified person will then confirm correct tube placement.
9. Secure tube in place to a stable facial structure.
10. If intubation is unsuccessful, maintain cricoid pressure and provide BVM
ventilation until the paralytic wears off, or consider use of the LMA or combitube.
11. If patient becomes agitated, administer midazolam 1 mg every 1 – 2 min. until
patient is calm, BP drops, or max. 10 mg is utilized. Further doses may be given by
direct medical control.
If a long transport is anticipated, consider administering vecuronium (0.1 mg/kg).
Remember sedation is still required when vecuronium is utilized.
http://www.google.com/url?sa=t&ct=res&cd=6&url=http%3A%2F%2Fwww.scdhec.net%2Fhealth%2Fems%2Frsi.pdf&ei=JpbtRt6uCJC8iAG6jcXJBg&usg=AFQjCNG6wmyVf21r8vDl1NviM0rBgN1sUg&sig2=TZ4OiUStnJPN9iQSw_TjCw
More:
http://www.chestjournal.org/cgi/content/full/127/4/1397
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol3n2/rapid.xml
See what happens? LOL
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