T If you are sedated then you might as well be paralyzed right? Anyhow I guess when this would come into play would be with asthmatics, if standard epi didn't fix them.
No. There must be some serious consideration when you paralyze someone as well as determinining if the paralytic you are giving is the correct one. If you paralyze a patient just enough to hamper their respiratory effort but not enough for you to get control of their airway either with a tube or BVM, you will severely harm that patient. And, just getting the tube in is only half the battle. You must have enough knowledge and protocols to maintain that tube. If their gag is very active, they will struggle against that tube making ventilation very difficult causing more pulmonary and ICP complications than what they may have had without the tube.
As well, when paralyze someone, you are knocking out part of their own natural systemic pump for venous return. This can be very critical if you managing a cardiac or CHF patient. Short acting paralytics may be fine but again there may be other factors that you must be aware of even with those and may need to support their blood pressure through pressors or fluids. This is especially true if you use something like Versed as sedation.
Also, for the asthmatic, that patient may be given an initial dose of a steroid in the field. Some paralytics and steroids interact with each other and permanent paralysis may be one of the side effects.
Even in the hospital or on long transports we will avoid the use of paralytics for either intubation or maintenance of a patient on a ventilator. However, it takes extensive knowledge of pharmacology to fit the patient and the situation. Of course, when the patient presents a safety risk to himself and the crew such as in a helicopter flight, whatever needs to be done will be done but again that crew should have been well educated for these decisions.
The problem with the way EMS education is done now is that everything is looked at as a separate entity or recipe. The procedure of RSI is looked at as just a method of intubation without examining the meds or the if this then as it only pertains to alternative airways. When people make out med cards, they are usually very specific. This drug is used for this. They don't always cross over such as "I can give steroids for asthma" and "I can give a paralytic for RSI and to maintain the patient for airway management". Many will view this as two separate pathways independent of the other.
Once you've taken the step into doing advanced procedures such as RSI with medications such as paralytics, you can no longer just look at "skills" but now must become knowledgable about medicine and how what each thing you do will have a reaction for the action.
