Guest guest Posted March 22, 2005 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted 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. > > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 sux half of the ambulances have built in refrigerators, half don't the half don't replace sux every two weeks (on pay day); cost is about 1.5 dollars for each unit every two weeks john 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 sux half of the ambulances have built in refrigerators, half don't the half don't replace sux every two weeks (on pay day); cost is about 1.5 dollars for each unit every two weeks john 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 sux half of the ambulances have built in refrigerators, half don't the half don't replace sux every two weeks (on pay day); cost is about 1.5 dollars for each unit every two weeks john 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. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.