----- Original Message -----
Sent: Thursday, November 13, 2003 5:28
PM
Subject: [traumanurses] Re: Combative
brain injured patients
The brain trauma foundation -has really standardized our
practice. The "gold" standard for them is to intubate patients who are GCS
< 9 to protect the airway. GCS between 9 and 13 has been very
individualized. We have at times convinced the MD's to intubate if it takes
all of the nursing staff and security staff to keep a patient safe.
Drugs - well our neurosurgeons have asked us to stop using
long active benzo's prior to their arrival so that they can assess the
patient. Our standard at this time is to use Esmolol bolus in air and drips on
ground. Up until we stumbled onto this happy medium the neurosurgeons were
having to use electric muscle stimulator to ellicite neuromuscular responses.
Now they can shut off the Esmolol and within minutes they can do a complete
exam and we can turn the medication on and wean towards longer acting benzo's
/ paralytics / sedatives / pain medications etc...
This seems to be working well for us at this time.
Lisa McLaughlin
Santa Fe, NM
87505
505-820-5708
-----Original Message-----
From:
Carolyn Koehler [mailto:koehlercarolyn@hotmail.com]
Sent: Thursday, November 13, 2003 2:47 PM
To: TraumaNurses@TraumaNurseSoc.org
Subject:
(no subject)
Hello All,
Our facility recently had an intoxicated combative trauma patient with
high potential for a head injury. This case
prompted discussion regarding
sedation without
intubation vs. sedation/paralytics with intubation. Does
anyone have any literature/thoughts etc. regarding
these types of patients?
What drugs are most
appropriate? When to intubate? -Lots of legal/medical
components.
Thanks, Carolyn
Koehler APRN
Trauma Coordinator
Missoula, MT
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