Critique this RSI protocol.

[Carlos Danger]

Anyone want to chime in on the dosage of the versed? I know 2mg is an extremely small amount for the awake patient, but I also know that opioids (fent) help to potentiate the effects of the midazolam. How much does the drug-drug interaction affect the potency? Also, what is the point of the administration of versed if you're going to give Ketamine shortly after?

I personally don't see any reason to give fentanyl + versed + ketamine.

 

[FiremanMike]

<shrug> I give it because the nice doctor who says I can be a paramedic tells me I need to

In all seriousness, if there's anything I don't like about our protocol it's the wasting of time on the premedication phase. I see no reason to waste time there and would prefer to shoot straight to my rocketamine. He does allow for this in a crash airway scenario, as long as we can articulate why.

If I had to guess, he just wants us to snow them as much as possible.

 

[SpecialK]

Our procedures is fentanyl over one minute given two minutes before inducing anaesthesia. Preoxygenation for 2-3 minutes with a reservoir mask if possible, if the patient is a bit agitated and fighty I'll give 2-3 mg of midazolam to settle then down to tolerate this, or could give them a sub anaesthetic dose of ketamine for the same purpose, say 1 mg/kg.

Really wish we had mechanical ventilation especially for longer transports. No way this will happen in the foreseeable future due to the cost. HEMS and the HEMS car have a little Oxylog that's pretty cool.