Hi all,
In regard to heavily intoxicated patients and CT issues. If the GCS is less
than 8, we intubate. In other cases we will electively intubate to "protect
the patient". We use rapid sequence intubation in all cases with drug choices
(all weight based) being: lidocaine (used with all suspected head injuries;
either etomidate or versed (dependant on physician choice); succinycholine;
vecuronium for paralysis. Vec usage is a judgment call due to length of
paralysis. If we have a high index of suspicion of bleed, we will use a
propofol drip to keep the patient down. This works very nicely with a fast
half life, therefore we can just turn it off we neurosurgery arrives.
Brian J. Green
Trauma Program Manager
St. John Hospital and Medical Center
313 343 7309
-----Original Message-----
From: ListServe.com Listar Server [mailto:listar@mailman.listserve.com]
Sent: Saturday, November 15, 2003 12:02 AM
To: traumanurses digest users
Subject: traumanurses Digest V2 #268
traumanurses Digest Fri, 14 Nov 2003 Volume: 02 Issue: 268
In This Issue:
[traumanurses] Re: traumanurses Digest V2 #267
[traumanurses] Re: Combative brain injured patients
[traumanurses] SafetyLit: 17 November 2003 (early)
[traumanurses] Re: (no subject)
[traumanurses] Re: Combative brain injured patients
----------------------------------------------------------------------
From: "Banner, Dixie" <DBANNER@SJMC.ORG>
Subject: [traumanurses] Re: traumanurses Digest V2 #267
Date: Fri, 14 Nov 2003 07:49:48 -0600
Ah, the "repatriation" issue! If anyone has one I'd love to get a
copy, too!
Dixie Banner
-----Original Message-----
From: ListServe.com Listar Server
[mailto:listar@mailman.listserve.com]
Sent: Thursday, November 13, 2003 11:02 PM
To: traumanurses digest users
Subject: traumanurses Digest V2 #267
traumanurses Digest Thu, 13 Nov 2003 Volume: 02 Issue: 267
In This Issue:
[traumanurses] Re: (No Date: Thu, 13 Nov 2003 08:33:57
-0500
[traumanurses] Re: (No Date: Thu, 13 Nov 2003 08:33:57
-0500
[traumanurses] Re: Radio communication recording
[traumanurses] Re: (No Date: Thu, 13 Nov 2003 08:33:57
-0500
(no subject)
[traumanurses] Re: (no subject)
[traumanurses] Re: Combative brain injured patients
----------------------------------------------------------------------
From: "Shepherd, Mary" <mary.shepherd@choa.org>
Subject: [traumanurses] Re: (No Date: Thu, 13 Nov 2003 08:33:57 -0500
Does any one have a transfer agreement with outlying hospitals in
where it states that after the stabilization and the patient no longer
requires the specialized service of your facility they will be
transferred back to the hospital that sent them to you?
Mary Shepherd
------------------------------
Date: Thu, 13 Nov 2003 07:46:51 -0600
From: "Dan Burgess" <dburgess@mhg.com>
Subject: [traumanurses] Re: (No Date: Thu, 13 Nov 2003 08:33:57 -0500
Ours says that they "may be" not necessarily "will be".
The repatriation clause in most of the ones floating around that I
have seen is designed to help the referral facility move patients
through so that they can avoid saturation and provide acute care.
Dan P Burgess RN
>>> mary.shepherd@choa.org 11/13/03 07:36AM >>>
Does any one have a transfer agreement with outlying hospitals in
where it states that after the stabilization and the patient no longer
requires the specialized service of your facility they will be
transferred back to the hospital that sent them to you?
Mary Shepherd
To Digest or put your listserve on "vacation hold" refer to listserve
page on the website. STN does not accept the following: Coarse or
vulgar language, disparaging or untruthful remarks about health care
professionals or institutions, job postings, or comments which
otherwise would indicate a lack of respect or regard for trauma
nursing or anything deemed inappropriate by the webmaster.
Subscribers who do not comply will be unsubscribed. STN does not take
any responsibility for the information shared on this listserve.
------------------------------
From: "Kosakowski, Jacqueline" <Jacqueline.Kosakowski@choa.org>
Subject: [traumanurses] Re: Radio communication recording
Date: Thu, 13 Nov 2003 10:38:50 -0500
Jacqueline Kosakowski RN, MSN
-----Original Message-----
From: Margot.Daugherty@MiddletownHospital.org
[mailto:Margot.Daugherty@MiddletownHospital.org]
Sent: Wednesday, November 12, 2003 5:17 PM
To: traumanurses@listserve.com
Subject: [traumanurses] Re: Radio communication recording
We use a Dolby system. I have access from my desktop to monitor or
retrieve archived calls. Call me and I would be happy to share more
information. Margot
Margot Daugherty, RN
Trauma Program Manager
Middletown Regional Hospital
105 McKnight Drive
Middletown OH 45044
513-420-5186
513-420-5753 (fax)
-----Original Message-----
From: Dan Burgess [mailto:dburgess@mhg.com]
Sent: Wednesday, November 12, 2003 11:47 AM
To: TraumaNurses@TraumaNurseSoc.org
Subject: [traumanurses] Radio communication recording
We are investigating a new digital system for monitoring radio
communications between our control room and the ambulances. Would
anyone be willing to share the type of system you are using (including
vendor) and how it works for you?
Thank-you
Dan P Burgess RN
Memorial Hospital
Gulfport MS
To Digest or put your listserve on "vacation hold" refer to listserve
page on the website. STN does not accept the following: Coarse or
vulgar language, disparaging or untruthful remarks about health care
professionals or institutions, job postings, or comments which
otherwise would indicate a lack of respect or regard for trauma
nursing or anything deemed inappropriate by the webmaster.
Subscribers who do not comply will be unsubscribed. STN does not take
any responsibility for the information shared on this listserve.
To Digest or put your listserve on "vacation hold" refer to listserve
page on the website. STN does not accept the following: Coarse or
vulgar language, disparaging or untruthful remarks about health care
professionals or institutions, job postings, or comments which
otherwise would indicate a lack of respect or regard for trauma
nursing or anything deemed inappropriate by the webmaster.
Subscribers who do not comply will be unsubscribed. STN does not take
any responsibility for the information shared on this listserve.
------------------------------
Date: Thu, 13 Nov 2003 08:47:00 -0700
From: "Karen Mickelson" <Karen.Mickelson@hsc.utah.edu>
Subject: [traumanurses] Re: (No Date: Thu, 13 Nov 2003 08:33:57 -0500
I have this one. It is a standard agreement form that any hospital in
Utah can use. Most of the larger trauma centers have their own
already, but the state developed this one for those that don't. Look
under 9 B. for the wording. Karen Mickelson RN BSN Trauma Educator
Trauma Services University of Utah Hospitals & Clinics 50 N. Medical
Dr. P3250B Salt Lake City, Utah 84132
office: (801) 585-2991
pager: 339-0870
>>> mary.shepherd@choa.org 11/13/03 06:36AM >>>
Does any one have a transfer agreement with outlying hospitals in
where it states that after the stabilization and the patient no longer
requires the specialized service of your facility they will be
transferred back to the hospital that sent them to you?
Mary Shepherd
To Digest or put your listserve on "vacation hold" refer to listserve
page on the website. STN does not accept the following: Coarse or
vulgar language, disparaging or untruthful remarks about health care
professionals or institutions, job postings, or comments which
otherwise would indicate a lack of respect or regard for trauma
nursing or anything deemed inappropriate by the webmaster.
Subscribers who do not comply will be unsubscribed. STN does not take
any responsibility for the information shared on this listserve.
------------------------------
From: "Carolyn Koehler" <koehlercarolyn@hotmail.com>
Date: Thu, 13 Nov 2003 16:47:16 -0500
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
_________________________________________________________________
From Beethoven to the Rolling Stones, your favorite music is always
playing
on MSN Radio Plus. No ads, no talk. Trial month FREE!
http://join.msn.com/?page=offers/premiumradio
------------------------------
Date: Thu, 13 Nov 2003 15:23:46 -0700
From: "Marcia Hall" <MKHall@salud.unm.edu>
Subject: [traumanurses] Re: (no subject)
We have a lot of this. If they need a CT, or medical treatment, and
there GCS is 8 or <, we will intubate. Always, always use
paralytics,& sedation. We are not sure which drugs, anesthesia
usually will have a favorite. There isn't a legal issue, you do what
ever you have to , to give them the care they need. Or you will have
a legal issue. Protect them from themselves.
Marcia Hall RN, CNOR
Trauma Coordinator
University Hospital
Albuquerque, NM
Office: 505-272-1835
pager: 505-530-7222
mkhall@salud.unm.edu
>>> koehlercarolyn@hotmail.com 11/13/03 2:47:16 PM >>>
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
_________________________________________________________________
From Beethoven to the Rolling Stones, your favorite music is always
playing
on MSN Radio Plus. No ads, no talk. Trial month FREE!
http://join.msn.com/?page=offers/premiumradio
To Digest or put your listserve on "vacation hold" refer to listserve
page on the website. STN does not accept the following: Coarse or
vulgar language, disparaging or untruthful remarks about health care
professionals or institutions, job postings, or comments which
otherwise would indicate a lack of respect or regard for trauma
nursing or anything deemed inappropriate by the webmaster.
Subscribers who do not comply will be unsubscribed. STN does not take
any responsibility for the information shared on this listserve.
------------------------------
From: "Leiding, Lisa" <Lisa.Leiding@stvin.org>
Subject: [traumanurses] Re: Combative brain injured patients
Date: Thu, 13 Nov 2003 15:28:45 -0700
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
_________________________________________________________________
From Beethoven to the Rolling Stones, your favorite music is always
playing
on MSN Radio Plus. No ads, no talk. Trial month FREE!
http://join.msn.com/?page=offers/premiumradio
To Digest or put your listserve on "vacation hold" refer to listserve
page on the website. STN does not accept the following: Coarse or
vulgar language, disparaging or untruthful remarks about health care
professionals or institutions, job postings, or comments which
otherwise would indicate a lack of respect or regard for trauma
nursing or anything deemed inappropriate by the webmaster.
Subscribers who do not comply will be unsubscribed. STN does not take
any responsibility for the information shared on this listserve.
------------------------------
End of traumanurses Digest V2 #267
**********************************
------------------------------
Date: Fri, 14 Nov 2003 09:35:56 -0700
From: "Russ Wilshaw" <russ.wilshaw@ihc.com>
Subject: [traumanurses] Re: Combative brain injured patients
Lisa,
Are you saying etomidate? Esmolol has no sedating properties and is a
beta blocker.
Thanks,
Russ Wilshaw RN, MS
Trauma Coordinator
UVRMC
Provo, Utah
>>> Lisa.Leiding@stvin.org 11/13/03 03:28PM >>>
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
_________________________________________________________________
From Beethoven to the Rolling Stones, your favorite music is always
playing
on MSN Radio Plus. No ads, no talk. Trial month FREE!
http://join.msn.com/?page=offers/premiumradio
To Digest or put your listserve on "vacation hold" refer to listserve
page
on the website. STN does not accept the following: Coarse or vulgar
language, disparaging or untruthful remarks about health care
professionals
or institutions, job postings, or comments which otherwise would
indicate a
lack of respect or regard for trauma nursing or anything deemed
inappropriate by the webmaster. Subscribers who do not comply will be
unsubscribed. STN does not take any responsibility for the
information
shared on this listserve.
------------------------------
From: "Hotz, Heidi, RN" <Heidi.Hotz@cshs.org>
Subject: [traumanurses] SafetyLit: 17 November 2003 (early)
Date: Fri, 14 Nov 2003 08:43:30 -0800
> ----------
> From: david.lawrence@sdsu.edu[SMTP:david.lawrence@sdsu.edu]
> Reply To: david.lawrence@sdsu.edu
> Sent: Thursday, November 13, 2003 5:16 PM
> To: Heidi Hotz
> Subject: SafetyLit: 17 November 2003 (early)
>
>
> SafetyLit is a service of the
> Center for Injury Prevention Policy and Practice
> at San Diego State University.
>
>
>
> The most recent update is available now at: <http://www.safetylit.org>
>
>
>
> This week's update is being released three days early to allow SafetyLit
> staff to attend the American Public Health Association annual conference.
>
>
> This week you may read abstracts of the following reports:
>
>
> Alcohol and Other Drugs:
>
>
> Watering down the drinks: the moderating effect of college demographics on
> alcohol use of high-risk groups.
>
>
> - Wechsler H, Kuo M. Am J Public Health 2003; 93(11): 1929-1933.
>
>
> See item 1 under Research
>
>
> See item 3 under Violence
>
>
> Commentary and Editorials:
>
>
> Providing free smoke alarms did not reduce fire related injuries in a
> deprived multiethnic urban population: Commentary on publications by
> DiGuiseppi and by Mallonee.
>
>
> - Ehrlich A. Evid Based Nurs 2003; 6(4): 105.
>
>
> Community-Based Prevention:
>
>
> Evaluation activities to strengthen an injury prevention resource center
> for urban families.
>
>
> - McDonald EM, Gielen AC, Trifiletti LB, Andrews JS, Serwint JR, Wilson
> ME. Health Promot Pract 2003; 4(2): 129-137.
>
>
> Parents of fatally injured children discuss taking part in prevention
> campaigns: an exploratory study.
>
>
> - Girasek DC. Death Stud 2003; 27(10): 929-37.
>
>
> Disasters and Environmental Issues:
>
>
> Crush injury and crush syndrome: a consensus statement.
>
>
> - Porter K, Greaves I. Emerg Nurse 2003; 11(6): 26-30.
>
>
> Distraction and Intentional Issues:
>
>
> A chamber-experiment investigation of the interaction between perceptions
> of noise and odor in humans.
>
>
> - Pan Z, Kjaergaard SK, Molhave L. Int Arch Occup Environ Health 2003;
> 76(8): 598-604.
>
>
> Ergonomics and Human Factors:
>
>
> No reports this week
>
>
> Home and Consumer Product Issues:
>
>
> No reports this week
>
>
> Occupational Issues:
>
>
> A practical approach to fire hazard analysis for offshore structures.
>
>
> - Krueger J, Smith D. J Hazard Mater 2003; 104(1-3): 107-22.
>
>
> Incidence and prevention of occupational electrical accidents.
>
>
> - Goffeng LO, Veiersted KB, Moian R, Remo E, Solli A, Erikssen J. Tidsskr
> Nor Laegeforen 2003; 123(17): 2457-2458.
>
>
> Magnitude and risk factors of injuries in a glass bottle manufacturing
> plant.
>
>
> - Bazroy J, Roy G, Sahai A, Soudarssanane MB. J Occup Health 2003; 45(1):
> 53-59.
>
>
> Pedestrian and Bicycle Issues:
>
>
> Educating grade school children using a structured bicycle safety program.
>
>
> - Nagel RW, Hankenhof BJ, Kimmel SR, Saxe JM. J Trauma 2003; 55(5):
> 920-923.
>
>
> See item 1 under Sensing & Response Issues
>
>
> Poisoning:
>
>
> No reports this week
>
>
> Recreation and Sports:
>
>
> Rugby headgear study.
>
>
> - McIntosh AS, McCrory P, Finch CF, Chalmers DJ, Best JP. J Sci Med Sport
> 2003; 6(3): 355-358.
>
>
> Injury in junior Australian Rules footballers.
>
>
> - Grimmer K, Williams J. J Sci Med Sport 2003; 6(3): 328-338.
>
>
> The neuropsychology of heading and head trauma in Association Football
> (soccer): a review.
>
>
> - Rutherford A, Stephens R, Potter D. Neuropsychol Rev 2003; 13(3):
> 153-179.
>
>
> Sex Differences and the Incidence of Concussions Among Collegiate
> Athletes.
>
>
> - Covassin T, Swanik CB, Sachs ML. J Athl Train 2003; 38(3): 238-244.
>
>
> Research Methods:
>
>
> Evaluation of race and ethnicity on alcohol and drug testing of
> adolescents admitted with trauma.
>
>
> - Marcin JP, Pretzlaff RK, Whittaker HL, Kon AA. Acad Emerg Med 2003;
> 10(11): 1253-1259.
>
>
> The connection between trauma and dissociation: a critical evaluation.
>
>
> - Cima M, Merckelbach H, Hollnack S, Knauer E. Fortschr Neurol Psychiatr
> 2003; 71(11): 600-608.
>
>
> Risk Factor Prevalence, Injury Occurrence, and Costs:
>
>
> See items under Occupational Issues
>
>
> See item 4 under Recreation and Sports
>
>
> See item 1 under Transportation
>
>
> Risk Perception and Communication:
>
>
> Effects of gun admonitions on the behaviors and attitudes of school-aged
> boys.
>
>
> - Hardy MS. J Dev Behav Pediatr 2003; 24(5): 352-358.
>
>
> Parental knowledge and children's use of bicycle helmets.
>
>
> - Bernstein JD, Harper MA, Pardi LA, Christopher NC. Clin Pediatr 2003;
> 42(8): 673-677.
>
>
> Determinism, risk and safe driving behavior in northern Alberta, Canada.
>
>
> - Rothe JP, Elgert L. Int J Circumpolar Health 2003; 62(3): 268-275.
>
>
> Rural and Agricultural Issues:
>
>
> The challenges of trauma care in the rural setting.
>
>
> - Helling TS. Mo Med 2003; 100(5): 510-514.
>
>
> Contributing factors to engulfments in on-farm grain storage bins: 1980
> through 2001.
>
>
> - Kingman DM, Deboy GR, Field WE. J Agromedicine 2003;9(1):39-63.
>
>
> See item 3 under Risk Perception
>
>
> See item 2 under Suicide
>
>
> School Issues:
>
>
> See item 1 under Pedestrian & Bicycle Issues
>
>
> Sensing and Response Issues:
>
>
> Multisensory integration in speed estimation during self-motion.
>
>
> - Sun HJ, Lee AJ, Campos JL, Chan GS, Zhang DH. Cyberpsychol Behav 2003;
> 6(5): 509-518.
>
>
> Comparison of balance in older people with and without visual impairment.
>
>
> - Lee HK, Scudds RJ. Age Ageing 2003; 32(6): 643-649.
>
>
> Suicide and Self Harm:
>
>
> Perceived Causes of Suicide Attempts by U.K. South Asian Women.
>
>
> - Hicks MH, Bhugra D. Am J Orthopsychiatry 2003; 73(4): 455-462.
>
>
> Toward understanding youth suicide in an Australian rural community.
>
>
> - Bourke L. Soc Sci Med 2003; 57(12): 2355-2365.
>
>
> A stubborn behaviour: the failure of antidepressants to reduce suicide
> rates.
>
>
> - Van Praag HM. World J Biol Psychiatry 2003; 4(4): 184-191.
>
>
> Transportation:
>
>
> Motor vehicle crash fatalities among Hispanics in rural North Carolina.
>
>
> - March JA, Evans MA, Ward B, Brewer KL. Acad Emerg Med 2003; 10(11):
> 1249-1252.
>
>
> Traumatic brain injury and automotive design: making motor vehicles safer.
>
>
> - Nirula R, Kaufman R, Tencer A. J Trauma 2003; 55(5): 844-848.
>
>
> See item 3 under Risk Perception
>
>
> Violence and Weapons:
>
>
> Aggression and violence: perspectives on integrating animal and human
> research approaches.
>
>
> - Lederhendler II. Horm Behav 2003; 44(3): 156-160.
>
>
> What can animal aggression research tell us about human aggression?
>
>
> - Blanchard DC, Blanchard RJ. Horm Behav 2003; 44(3): 171-177.
>
>
> Neurosteroids, GABA(A) receptors, and escalated aggressive behavior.
>
>
> - Miczek KA, Fish EW, De Bold JF. Horm Behav 2003; 44(3): 242-257.
>
>
> "Screening" for domestic violence.
>
>
> - Shaw D. J Obstet Gynaecol Can 2003; 25(11): 918-921.
>
>
> Intimate partner violence and depression among Whites, Blacks, and
> Hispanics.
>
>
> - Caetano R, Cunradi C. Ann Epidemiol 2003; 13(10): 661-665.
>
>
> See item 1 under Risk Perception
>
> _____
>
>
> View abstracts of these reports at: <http://www.safetylit.org>
>
>
> I hope that you find this service useful. However, if you wish to leave
> this mailing list there are two options:
>
> 1) Click on the following link. It should automatically create a blank
> email message with your unique SafetyLit member number encoded into the
> address. Simply send this blank message and your address will
> automatically be removed. This is a particularly helpful method for those
> who may have had subtle or not-so-subtitle changes in your email address
> from the one that was used to join SafetyLit.
> leave-safetylit-22001388C@lyris.dundee.net
> <mailto:leave-safetylit-22001388C@lyris.dundee.net>
>
> 2) Send me an email message at the address below and your address will be
> removed before the next week's issue.
>
> David Lawrence -- David.Lawrence@SDSU.edu
> Director, Center for Injury Prevention Policy and Practice
> Graduate School of Public Health
> San Diego State University
> 6505 Alvarado Road, Suite 208
> San Diego, CA 92120
> Voice: 619-594-3691 Fax: 619-594-1995
> http://www.InjuryPreventionWeb.org
>
>
------------------------------
From: "pmanion" <pmanion@chartermi.net>
Subject: [traumanurses] Re: (no subject)
Date: Fri, 14 Nov 2003 19:06:19 -0500
In my facility this common situation-patient with at least the potential for
head injury being too combative to get to CT- is treated with RSI using
Lidocaine, etomidate, succinylcholine, possibly fentanyl and taken to CT.
We do not wait until the patient is quieter nor do we put these patients in
restraints. The urgency of the need to evaluate in the possible presence
of a surgical lesion more than justifies this procedure
Pat Manion
Trauma Coordinator
Genesys Regional Medical Center
ACS verified Level II
---- Original Message -----
From: "Carolyn Koehler" <koehlercarolyn@hotmail.com>
To: <TraumaNurses@TraumaNurseSoc.org>
Sent: Thursday, November 13, 2003 4:47 PM
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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------------------------------
From: "pmanion" <pmanion@chartermi.net>
Subject: [traumanurses] Re: Combative brain injured patients
Date: Fri, 14 Nov 2003 19:08:29 -0500
RE: Combative brain injured patientsEsmolol?
----- 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
_________________________________________________________________
From Beethoven to the Rolling Stones, your favorite music is always playing
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------------------------------
End of traumanurses Digest V2 #268
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