4 ms·

Opioids are rarely in RSI. RSI uses a sedative and a paralytic. The sedative is almost always a benzodiazapine, and occasionally a dissociative or hypnotic sed

Opioids are rarely in RSI. RSI uses a sedative and a paralytic. The sedative is almost always a benzodiazapine, and occasionally a dissociative or hypnotic sedative like ketamine or etomidate. Morphine would be a _very_ poor choice for a sedative in an RSI protocol.

FireBeyond 14y ago
Actually, no idea why I grabbed onto morphine in that discussion. Our protocols call for vecuronium, atropine, etomidate, succinylcholine. However, we do also use fentanyl if indicated to deal with tachycardia and ICP. One other thing I noted in the original article was bemoaning the lack of pulse oximetry, "to assess if patient was exchanging oxygen". Treat the patient, not the number. If your patient is in respiratory distress but has 100% SpO2, treat the distress. If your patient appears /comfortable/ and /normal/ at 90%, go with what seems appropriate to their case. (In fact, our MPD excludes Pulse Oximetry and Blood Glucose from BLS protocols on the grounds of 'treat the patient' - though my opinion tends to differ on the latter).
- cwb71 14y ago
  Reading between the lines just a little bit, I got the feeling based on the doc's description of his patient's behavior earlier in the flight that he suspected she was just being a drama queen and that this was more of a "psychiatric issue." Perhaps he wanted to test that hypothesis?
- jeltz 14y ago
  If I was the patient I would love to hear that my oxygen levels were normal and that I am not at any risk of dying any time soon. I would say treating the patient should include first measuring how urgent it is. Additionally if you panic you can easily imagine having trouble breathing, or that your trouble breathing is worse than it actually is. I have experienced this first hand when just relaxing removed most of my problems.
  - FireBeyond 14y ago
    There's a very interesting book I read called "The Worst Is Over", which discusses this very thing, and talk in detail about how to talk calmly, soothingly and reassuringly to your patient, and the benefits thereof, from the more obvious (anxiety) to the less (pain relief and the perception thereof).
- JshWright 14y ago
  PulseOx is great for trending treatments. If the pt starts out at 90%, and after your treatment is sat'ing in the mid-90's, that's a very useful datapoint. There are a few extremely important caveats with pulse oximetry. PulseOx is useless if your patient isn't perfusing their periphery well (either due to hypothermia, or shock). You also need to consider that it only measures the percentage of hemoglobin that is bound to _something_, that something could just as easily be carbon monoxide. The other commonly overlooked issue is that certain types of lights (fluorescent lights are the worst offender) play havoc with pulseox meters. Your average fluorescent light will happily sat in the mid-80's. Be sure to cover the finger (or toe) that the sensor is on with something opaque.
carbocation 14y ago
Fentanyl is reasonably commonly used.

FireBeyond 14y ago

Actually, no idea why I grabbed onto morphine in that discussion. Our protocols call for vecuronium, atropine, etomidate, succinylcholine. However, we do also use fentanyl if indicated to deal with tachycardia and ICP. One other thing I noted in the original article was bemoaning the lack of pulse oximetry, "to assess if patient was exchanging oxygen". Treat the patient, not the number. If your patient is in respiratory distress but has 100% SpO2, treat the distress. If your patient appears /comfortable/ and /normal/ at 90%, go with what seems appropriate to their case. (In fact, our MPD excludes Pulse Oximetry and Blood Glucose from BLS protocols on the grounds of 'treat the patient' - though my opinion tends to differ on the latter).

cwb71 14y ago
Reading between the lines just a little bit, I got the feeling based on the doc's description of his patient's behavior earlier in the flight that he suspected she was just being a drama queen and that this was more of a "psychiatric issue." Perhaps he wanted to test that hypothesis?
jeltz 14y ago
If I was the patient I would love to hear that my oxygen levels were normal and that I am not at any risk of dying any time soon. I would say treating the patient should include first measuring how urgent it is. Additionally if you panic you can easily imagine having trouble breathing, or that your trouble breathing is worse than it actually is. I have experienced this first hand when just relaxing removed most of my problems.
- FireBeyond 14y ago
  There's a very interesting book I read called "The Worst Is Over", which discusses this very thing, and talk in detail about how to talk calmly, soothingly and reassuringly to your patient, and the benefits thereof, from the more obvious (anxiety) to the less (pain relief and the perception thereof).
JshWright 14y ago
PulseOx is great for trending treatments. If the pt starts out at 90%, and after your treatment is sat'ing in the mid-90's, that's a very useful datapoint. There are a few extremely important caveats with pulse oximetry. PulseOx is useless if your patient isn't perfusing their periphery well (either due to hypothermia, or shock). You also need to consider that it only measures the percentage of hemoglobin that is bound to _something_, that something could just as easily be carbon monoxide. The other commonly overlooked issue is that certain types of lights (fluorescent lights are the worst offender) play havoc with pulseox meters. Your average fluorescent light will happily sat in the mid-80's. Be sure to cover the finger (or toe) that the sensor is on with something opaque.

carbocation 14y ago

Fentanyl is reasonably commonly used.