etomidate

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?

Originally posted by Medic946RN

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.

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?":chuckle

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

ha ha ha, don't ya love it....

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'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!! :imbar :chuckle

thanks all, I now am comfortable to push it since it is within our scope. thanks again.

xo Jen