Airway Management in Head Trauma (Scenerio)

Chase said:
Cardiac Tech is not a Perfusionist....
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Yes, understood - probably some unhelpful context on my part. U.S. DOL didn't break out (or even identify) perfusionists, so I figured it'd be worthwhile to add a similar - cardiology focused - tech.
 
EpiEMS said:
Yes, understood - probably some unhelpful context on my part. U.S. DOL didn't break out (or even identify) perfusionists, so I figured it'd be worthwhile to add a similar - cardiology focused - tech.
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It’s really not a bad gig. Some places you can still get a bachelors degree and go make $100k+.

I think I’d enjoy it but not really a great career move for me personally. Thinking about becoming a RN ECMO specialist
 
Chase said:
It’s really not a bad gig. Some places you can still get a bachelors degree and go make $100k+.

I think I’d enjoy it but not really a great career move for me personally. Thinking about becoming a RN ECMO specialist
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I worked with someone who did that part time, made good money especially if you do traveling
 
Im way late to this party.. Id say Just place an I-Gel and hit the road. This is a time sensitive call, we are 40 minutes away from a Trauma Center. The best thing for this patient is an quick ride to the trauma doc (hopefully within the Golden Hour). We can protect his airway by dropping and I-Gel. We can administer a paralytic to control ventilations if we fear herniation. Other then that keep the patient warm and dont allow a period of hypoxia or hypotension.
 
bizzy522 said:
Im way late to this party.. Id say Just place an I-Gel and hit the road. This is a time sensitive call, we are 40 minutes away from a Trauma Center. The best thing for this patient is an quick ride to the trauma doc (hopefully within the Golden Hour). We can protect his airway by dropping and I-Gel. We can administer a paralytic to control ventilations if we fear herniation. Other then that keep the patient warm and dont allow a period of hypoxia or hypotension.
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I don't necessarily disagree, but the whole golden hour thing is kind of bunk. Obviously this patient needs to be transported quickly, but not at the expense of proper care (which may or may not be airway management).
 
I'm coming in to this very late and I didn't read many responses so I am going to type and see what the group thinks......

Given the scenario, pt needs to be intubated via RSI but lets hold the Etomidate, why..... because it works on the adrenal cortex and could HYPOTHETICALLY reduce the amount of epi/norepi helping the sympathetic nervous system. RSI the pt with Ketamine, Succ and Fentanyl........after confirmation and checking the BP use Versed (midazolam), and fentanyl for sedation with maybe ROC as necessary. Standard Vent settings 6mL/kg, 5 PEEP, 10 PS, Fi02 80% (ween to ETC02 40).

Meds in addition to sedation, TXA. Watch the BP because we don't want in to get too low (Monroe-Kelly doctrine).

If you have an aircraft service worth anything an auto-launch should've already been accomplished given to mechanism alone with a van in the crash. Even though this pt has an obvious HI rotor wing transport is not contraindicated. Pt with a pneumocephalic would only be at risk for further damage because blood doesn't expand at altitude, only air.

My $0.02.
 
grumpy1 said:
I'm coming in to this very late and I didn't read many responses so I am going to type and see what the group thinks......

Given the scenario, pt needs to be intubated via RSI but lets hold the Etomidate, why..... because it works on the adrenal cortex and could HYPOTHETICALLY reduce the amount of epi/norepi helping the sympathetic nervous system.
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It reduces serum cortisol levels for a day...might be an issue in sepsis patients, probably not in this scenario. If it isn't chosen, this isn't the reason not to choose it.
 
Also, these patients usually have already had a significant catecholamine surge and are catecholamine depleted by the time we arrive.
 
E tank said:
It reduces serum cortisol levels for a day...might be an issue in sepsis patients, probably not in this scenario. If it isn't chosen, this isn't the reason not to choose it.
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It was an outside the box thought and its always good to bounce those off others at times, good observation on the time.
 
Ketamine could also produce hypotension, though unlikely in this scenario. A single dose of etomidate is likely to have negligible effects. I'd use etomidate.
 
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