If there is reasonable evidence that the patient's combativeness could
be due to hypoxia from any source (head injury/shock) the patient gets
intubated. We use lidocaine, versed or etomidate, succ and then serial
hits w versed and vec to maintain the sedation/paralysis until the
patient is evaluated or determined to need continued sedation and
paralysis. The price of propofol has disallowed it's routine use as a
short acting sedative (much to our chagrin). Ketamine is another option
for short acting sedation but is contraindicated in head injury.
>>> pmanion@chartermi.net 11/14/03 07:08PM >>>
Esmolol?
----- Original Message -----
From: Leiding, Lisa
To: 'traumanurses@listserve.com'
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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