That was a mistake on my part - meant profolol.
Lisa
-----Original Message-----
From: Theresa Dinardo [mailto:Theresa.Dinardo@atlanticare.org]
Sent: Monday, November 17, 2003 8:38 AM
To: traumanurses@listserve.com
Subject: [traumanurses] Re: Combative brain injured patients
What role does esmolol have? We do not use this.
>>> Lisa.Leiding@stvin.org 11/13/03 05:28PM >>>
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
<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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