etomidate

Actually, in my flight nurse life, I must say that etomidate is the preferred drug for RSI in the trauma pt. Of course, this seemed beyond the scope of the initial question. Kevin is very correct in stressing the need to know the ins and outs of any medication being administered (forgive me for repeating myself). That said, I have never had a pt vomit after etomidate. This may be due to the lower doses administered in ER or to lack of drug interactions. Nonetheless, I do not agree that anaesthesia drugs should only be given by the various forms of gas passers. I do believe that proper training and education is crucial for the limited use outside of OR settings.

In the prehospital or transport arena I use it for rapid sequence intubation but in the ED it seems relegated to conscious sedation. If we're going to tube most docs prefer sux or nurcuron(sp?) along with a little versed.

Our protocol for RSI is Etomidate 20mg and Succinocholine 100mg. Post intubation we use vecuronium and/or propofol as necessary. For moderate/conscious sedation proceedures we use either propofol or versed. I've never seen Etomidate used for anything but RSI in our ER.

We use etomidate in the ER for intubation, usually 20 mg. I am allowed to push it (along with the sux), but I ONLY do it when the doctor is standing at the bedside with the tube and blade in his hand.

we dont use it in the ER, but I wish we did...


We are always behind everyone else. LOL

We use etomidate and succ for RSI too.......but what's the best post-intubation sedation? I've used fentanyl and versed drips and as IV pushes. With a little vec as a paralytic if necessary. We've just been approved to use diprovan (finally).....but I don't have much experience with it yet.
If you have head bleed or injury patient, what is the best post-induction sedation to use during their long wait for an ICU bed in the ER?

we use it for conscious sedation with fentinyl. used it on a kid with a wrist fx the other night!

the parents asked "is it fractured or just broke?"

ha ha ha, don't ya love it....
We've been using Diprivan for quite a while now and LOVE it. It works great for head bleeds/neuro. It works quickly and has a short half life which makes it much more preferable to versed/ativan gtts that can take days to wear off. With Diprivan we hold the gtt for about half an hour (sometimes you only need 5 minutes) before the pt starts to wake up. You can quickly do your assessment then restart the drip. Our protocol says that we can only go up to 50 mcg for our max dose. Higher if you have an MD order. Great drug-I think you'll like it!

I have to say...for intubation, we generally use versed and morphine...then if paralyzation is required (and only after the airway is protected), we use vecuronium.

We also use propofol (Diprivan) for continued sedation and yes, it is great for constant sedation...as it was mentioned above, it is WONDERFUL for neuro pt's. Also, the half life of the drug is only 5 minutes, so you can wake someone up in just a few minutes to assess them and then use a bolus to knock them back out quickly, if need be. In our unit, our max dose is 80 mcg/kg/min, despite drug books saying the max is around 100, I think.

The only bad thing about propofol is that it is a fatty emulsion and the long term effects on the liver and kidneys are not yet known.

WOW! I'm sooo not an ER nurse...I thought the post was going to be about a new dating show!!