Re: RSI Drugs

March 22, 2005

Good enough survey. As a suggestion - You might want to identify who you

are and the purpose for which you're surveying this for.

Our induction agent is Versed and we utilize two cooling systems within

our vehicles (small refrigerators vs. ice chests/freezer packs).

Don Elbert, Tyler

ETMC-EMS

Don't forget to attend EMStock May 21-22 - Midlothian, Texas -

www.emstock.com

>>> dnewman3@... 3/22/2005 10:31:23 AM >>>

For those of you who utilize RSI in your services, what type of

induction agent do you use.

The second part of that question is do you utilize a cooling system

within your responce vehicles or not and what is the replacement

policy if you do not.

The last question is what cost do you have to replace the agent if

discarded after a short time due to not using a cooling system.

March 22, 2005

Good enough survey. As a suggestion - You might want to identify who you

are and the purpose for which you're surveying this for.

Our induction agent is Versed and we utilize two cooling systems within

our vehicles (small refrigerators vs. ice chests/freezer packs).

Don Elbert, Tyler

ETMC-EMS

Don't forget to attend EMStock May 21-22 - Midlothian, Texas -

www.emstock.com

>>> dnewman3@... 3/22/2005 10:31:23 AM >>>

For those of you who utilize RSI in your services, what type of

induction agent do you use.

The second part of that question is do you utilize a cooling system

within your responce vehicles or not and what is the replacement

policy if you do not.

The last question is what cost do you have to replace the agent if

discarded after a short time due to not using a cooling system.

March 22, 2005

Good enough survey. As a suggestion - You might want to identify who you

are and the purpose for which you're surveying this for.

Our induction agent is Versed and we utilize two cooling systems within

our vehicles (small refrigerators vs. ice chests/freezer packs).

Don Elbert, Tyler

ETMC-EMS

Don't forget to attend EMStock May 21-22 - Midlothian, Texas -

www.emstock.com

>>> dnewman3@... 3/22/2005 10:31:23 AM >>>

For those of you who utilize RSI in your services, what type of

induction agent do you use.

The second part of that question is do you utilize a cooling system

within your responce vehicles or not and what is the replacement

policy if you do not.

The last question is what cost do you have to replace the agent if

discarded after a short time due to not using a cooling system.

March 22, 2005

In our system we pre-medicate with Lidocaine first

then administer in order: Versed, Succinylcholine,

Zemuron. Succinylcholine is kept on the units for 90

days at room temperature and then discarded. Zemuron

is discarded after 60 days. Being a smaller service

the cost factor for discarding the meds annually is

fairly low.

Jimmy Hoskins, EMS Director

Lake Whitney Medical Center EMS

--- D wrote:

>

> For those of you who utilize RSI in your services,

> what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a

> cooling system

> within your responce vehicles or not and what is the

> replacement

> policy if you do not.

>

> The last question is what cost do you have to

> replace the agent if

> discarded after a short time due to not using a

> cooling system.

>

__________________________________________________

March 22, 2005

In our system we pre-medicate with Lidocaine first

then administer in order: Versed, Succinylcholine,

Zemuron. Succinylcholine is kept on the units for 90

days at room temperature and then discarded. Zemuron

is discarded after 60 days. Being a smaller service

the cost factor for discarding the meds annually is

fairly low.

Jimmy Hoskins, EMS Director

Lake Whitney Medical Center EMS

--- D wrote:

>

> For those of you who utilize RSI in your services,

> what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a

> cooling system

> within your responce vehicles or not and what is the

> replacement

> policy if you do not.

>

> The last question is what cost do you have to

> replace the agent if

> discarded after a short time due to not using a

> cooling system.

>

__________________________________________________

March 22, 2005

In our system we pre-medicate with Lidocaine first

then administer in order: Versed, Succinylcholine,

Zemuron. Succinylcholine is kept on the units for 90

days at room temperature and then discarded. Zemuron

is discarded after 60 days. Being a smaller service

the cost factor for discarding the meds annually is

fairly low.

Jimmy Hoskins, EMS Director

Lake Whitney Medical Center EMS

--- D wrote:

>

> For those of you who utilize RSI in your services,

> what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a

> cooling system

> within your responce vehicles or not and what is the

> replacement

> policy if you do not.

>

> The last question is what cost do you have to

> replace the agent if

> discarded after a short time due to not using a

> cooling system.

>

__________________________________________________

March 22, 2005

Here in Fort Stockton we use versed to sedate, succinycholine, then

pavulon for the longer acting drug. If a head injury is involved, we

premedicate with lidocaine. These meds are kept in refrig along with

narcs and treated just like narcs, just due to the way they work and

potential risk of them falling into the wrong hands. Hope this helps.

Shanna Worthington EMT-P

EMS Director

Fort Stockton EMS

RSI Drugs

>

> For those of you who utilize RSI in your services, what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a cooling system

> within your responce vehicles or not and what is the replacement

> policy if you do not.

>

> The last question is what cost do you have to replace the agent if

> discarded after a short time due to not using a cooling system.

>

March 22, 2005

Here in Fort Stockton we use versed to sedate, succinycholine, then

pavulon for the longer acting drug. If a head injury is involved, we

premedicate with lidocaine. These meds are kept in refrig along with

narcs and treated just like narcs, just due to the way they work and

potential risk of them falling into the wrong hands. Hope this helps.

Shanna Worthington EMT-P

EMS Director

Fort Stockton EMS

RSI Drugs

>

> For those of you who utilize RSI in your services, what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a cooling system

> within your responce vehicles or not and what is the replacement

> policy if you do not.

>

> The last question is what cost do you have to replace the agent if

> discarded after a short time due to not using a cooling system.

>

March 22, 2005

Where is the evidence that lidocaine makes any difference?

Re: RSI Drugs

In our system we pre-medicate with Lidocaine first

then administer in order: Versed, Succinylcholine,

Zemuron. Succinylcholine is kept on the units for 90

days at room temperature and then discarded. Zemuron

is discarded after 60 days. Being a smaller service

the cost factor for discarding the meds annually is

fairly low.

Jimmy Hoskins, EMS Director

Lake Whitney Medical Center EMS

--- D wrote:

>

> For those of you who utilize RSI in your services,

> what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a

> cooling system

> within your responce vehicles or not and what is the

> replacement

> policy if you do not.

>

> The last question is what cost do you have to

> replace the agent if

> discarded after a short time due to not using a

> cooling system.

>

__________________________________________________

March 22, 2005

Where is the evidence that lidocaine makes any difference?

Re: RSI Drugs

In our system we pre-medicate with Lidocaine first

then administer in order: Versed, Succinylcholine,

Zemuron. Succinylcholine is kept on the units for 90

days at room temperature and then discarded. Zemuron

is discarded after 60 days. Being a smaller service

the cost factor for discarding the meds annually is

fairly low.

Jimmy Hoskins, EMS Director

Lake Whitney Medical Center EMS

--- D wrote:

>

> For those of you who utilize RSI in your services,

> what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a

> cooling system

> within your responce vehicles or not and what is the

> replacement

> policy if you do not.

>

> The last question is what cost do you have to

> replace the agent if

> discarded after a short time due to not using a

> cooling system.

>

__________________________________________________

March 22, 2005

Where is the evidence that lidocaine makes any difference?

Re: RSI Drugs

In our system we pre-medicate with Lidocaine first

then administer in order: Versed, Succinylcholine,

Zemuron. Succinylcholine is kept on the units for 90

days at room temperature and then discarded. Zemuron

is discarded after 60 days. Being a smaller service

the cost factor for discarding the meds annually is

fairly low.

Jimmy Hoskins, EMS Director

Lake Whitney Medical Center EMS

--- D wrote:

>

> For those of you who utilize RSI in your services,

> what type of

> induction agent do you use.

>

> The second part of that question is do you utilize a

> cooling system

> within your responce vehicles or not and what is the

> replacement

> policy if you do not.

>

> The last question is what cost do you have to

> replace the agent if

> discarded after a short time due to not using a

> cooling system.

>

__________________________________________________

March 23, 2005

Dr. Bledsoe,

I have always heard of lido being used to decrease intraocular pressure and

ICP in head injury patients during RSI attempts. Is this inaccurate now? I am

always trying to keep up, and this is a change I was not aware of. Could you

elaborate some?

Thanks

Chris

March 23, 2005

Dr. Bledsoe,

I have always heard of lido being used to decrease intraocular pressure and

ICP in head injury patients during RSI attempts. Is this inaccurate now? I am

always trying to keep up, and this is a change I was not aware of. Could you

elaborate some?

Thanks

Chris

March 23, 2005

At Refugio EMS we use Etomidate as our primary sedation agent with

Fentanyl as a backup. Intubation is attempted after the patient has

been sedated. If the patient remains non-flaccid, we then push

Succinylcholine. Once the patient has been tubed we wiil typically

follow up with Norcuron because of long transport times.

We have refrigerators in each of our units which are equipped with

generators. The refrigerators have allowed us to add Ativan and

Xopenex to our protocols.

Bill

March 23, 2005

At Refugio EMS we use Etomidate as our primary sedation agent with

Fentanyl as a backup. Intubation is attempted after the patient has

been sedated. If the patient remains non-flaccid, we then push

Succinylcholine. Once the patient has been tubed we wiil typically

follow up with Norcuron because of long transport times.

We have refrigerators in each of our units which are equipped with

generators. The refrigerators have allowed us to add Ativan and

Xopenex to our protocols.

Bill

March 23, 2005

At Refugio EMS we use Etomidate as our primary sedation agent with

Fentanyl as a backup. Intubation is attempted after the patient has

been sedated. If the patient remains non-flaccid, we then push

Succinylcholine. Once the patient has been tubed we wiil typically

follow up with Norcuron because of long transport times.

We have refrigerators in each of our units which are equipped with

generators. The refrigerators have allowed us to add Ativan and

Xopenex to our protocols.

Bill

March 23, 2005

" Intubation is attempted after the patient has

been sedated. "

From someone that has been on the receiving end of paralytics while still

conscious, PLEASE remember the sedation first!

Hollett RN, BSN, MA, MICN, CEN

Trauma Coordinator

Methodist Dallas Medical Center

1441 N. Beckley

Dallas, TX 75203

Re: RSI Drugs

At Refugio EMS we use Etomidate as our primary sedation agent with

Fentanyl as a backup. Intubation is attempted after the patient has

been sedated. If the patient remains non-flaccid, we then push

Succinylcholine. Once the patient has been tubed we wiil typically

follow up with Norcuron because of long transport times.

We have refrigerators in each of our units which are equipped with

generators. The refrigerators have allowed us to add Ativan and

Xopenex to our protocols.

Bill

March 23, 2005

" Intubation is attempted after the patient has

been sedated. "

From someone that has been on the receiving end of paralytics while still

conscious, PLEASE remember the sedation first!

Hollett RN, BSN, MA, MICN, CEN

Trauma Coordinator

Methodist Dallas Medical Center

1441 N. Beckley

Dallas, TX 75203

Re: RSI Drugs

At Refugio EMS we use Etomidate as our primary sedation agent with

Fentanyl as a backup. Intubation is attempted after the patient has

been sedated. If the patient remains non-flaccid, we then push

Succinylcholine. Once the patient has been tubed we wiil typically

follow up with Norcuron because of long transport times.

We have refrigerators in each of our units which are equipped with

generators. The refrigerators have allowed us to add Ativan and

Xopenex to our protocols.

Bill

March 23, 2005

" Intubation is attempted after the patient has

been sedated. "

From someone that has been on the receiving end of paralytics while still

conscious, PLEASE remember the sedation first!

Hollett RN, BSN, MA, MICN, CEN

Trauma Coordinator

Methodist Dallas Medical Center

1441 N. Beckley

Dallas, TX 75203

Re: RSI Drugs

At Refugio EMS we use Etomidate as our primary sedation agent with

Fentanyl as a backup. Intubation is attempted after the patient has

been sedated. If the patient remains non-flaccid, we then push

Succinylcholine. Once the patient has been tubed we wiil typically

follow up with Norcuron because of long transport times.

We have refrigerators in each of our units which are equipped with

generators. The refrigerators have allowed us to add Ativan and

Xopenex to our protocols.

Bill

March 23, 2005

Here is the issue: there is no actual evidence that proves lidocaine is

beneficial in lowering ICP. The Brain Trauma Foundation also says there is

no evidence that a single spike in ICP has detrimental effects. Most RSI

protocols include this to blunt the increased ICP produced by the

intubation. UMC in Lubbock did an in house study in the PICU in the mid

80's where they looked at the ICP via Mustang bolts in kids as they

underwent procedures such as ET suctioning to see if there were any

differences between those kids premedicated with lidocaine and those who

were not. The result was very dramatic, those kids premedicated had very

little if any increase in ICP but the ones who did not receive the lidocaine

had increases sometimes 40-50 points. I would say this might be like a lot

of other things we do in medicine, it is not evidence based but anecdotally

it works and has been adopted as a standard. I might be totally off base

but it has been in most RSI protocols for as long as I can remember.

Just my 2 cents

Lee

Re: RSI Drugs

>

> Dr. Bledsoe,

> I have always heard of lido being used to decrease intraocular pressure

> and

> ICP in head injury patients during RSI attempts. Is this inaccurate now? I

> am

> always trying to keep up, and this is a change I was not aware of. Could

> you

> elaborate some?

>

> Thanks

> Chris

>

March 23, 2005