Last call of the day is....

Transfer from local hospital to JoMo, Pt sustained a skull fracture and has a subdural hematoma and a pulmonary contusion. The initial call was for an unresponsve Pt who they believed was hit by a car. Pt was extremely intoxicated. He's intubated, on a Diprivan drip at 20ml/hr and a banana bag. Get him moved over to the cot, and he starts to wake up, receives a bolus dose of Diprivan at the ER. We depart, and he attempts to wake up twice more while en route to receiving facility. Got back just in time for shift change and to finish my paperwork...Ugh.
 
DEmedic said:
I still think proprofol is a lousy drug for transporting intubated patients. :/
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After this experience, I absolutely agree. At first, I was kind of freaking out (new Medic syndrome...I'm not perfect, don't judge me HAHA). Doesn't see, like they could give him enough to keep him down. Even at the receiving ER.
 
I thought about giving him some Roc, but since the Propofol drip was already running, I just gave him a bolus. It did the trick.
 
DEmedic said:
Fentanyl, Ativan and rocuronium.
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This. Our standard for sedation in transit is typically Fentanyl, and Versed; paralytic seem case dependant, IMO (see below).

Diprivan does have its place, and is great for some neuro cases. Apparently it's quite the neuroprotective agent for seizures, and stat ep patients; so I've been told.

Diprivan is a mild sedative, commonly used in the ICU as many attendings like to perform assessments on these patients when they make their daily rounds so that they can wean, and inevitably extubate them.

As far as paralysis goes, this is yet another on going debate depending on who you talk to, and is really done on a case by case basis.

Most of our scene call patients get a short acting paralytic (i.e., Succs), unless some event leading to their condition prevents them from being a candidate for it, such as a suspected eye injured patient, in which they would most like receive a longer acting, and more appropriate paralytic in Rocuronium.

If there's nothing barring us from giving said patient the depolarizing NMBA, it's Etomidate---> Succs--->ETI--->Fentanyl--->Versed. We're usually at the local hospital within a reasonable amount of time, and again, a lot of hospitals that I have seen seem to be moving away from the longer acting paralytic agents.

Also, for TBI patients on ground IFT, I may ask the RN if they would like the longer acting paralytic, as most of our IFT's (LDT's) are in the 2 hour range. So for them, if they are on Diprivan started by the sending facility, we may judiciously titrate the Diprivan up, give a non-depolarizing NMBA, dim the lights, try ear plugs if we have them, and coast along. These patients needs to be normotensive with a MAP (>/=) 60 mmHG, and VERY WELL oxygenated; these are thee mainly goals with any head injured patient.

I also try and adjust my vent settings to match the patient's condition, and/ or paralysis/ non- paralysis. Hope this helps, jteeters.
 
VentMonkey said:
This. Our standard for sedation in transit is typically Fentanyl, and Versed; paralytic seem case dependant, IMO (see below).

Diprivan does have its place, and is great for some neuro cases. Apparently it's quite the neuroprotective agent for seizures, and stat ep patients; so I've been told.

Diprivan is a mild sedative, commonly used in the ICU as many attendings like to perform assessments on these patients when they make their daily rounds so that they can wean, and inevitably extubate them.

As far as paralysis goes, this is yet another on going debate depending on who you talk to, and is really done on a case by case basis.

Most of our scene call patients get a short acting paralytic (i.e., Succs), unless some event leading to their condition prevents them from being a candidate for it, such as a suspected eye injured patient, in which they would most like receive a longer acting, and more appropriate paralytic in Rocuronium.

If there's nothing barring us from giving said patient the depolarizing NMBA, it's Etomidate---> Succs--->ETI--->Fentanyl--->Versed. We're usually at the local hospital within a reasonable amount of time, and again, a lot of hospitals that I have seen seem to be moving away from the longer acting paralytic agents.

Also, for TBI patients on ground IFT, I may ask the RN if they would like the longer acting paralytic, as most of our IFT's (LDT's) are in the 2 hour range. So for them, if they are on Diprivan started by the sending facility, we may judiciously titrate the Diprivan up, give a non-depolarizing NMBA, dim the lights, try ear plugs if we have them, and coast along. These patients needs to be normotensive with a MAP (>/=) 60 mmHG, and VERY WELL oxygenated; these are thee mainly goals with any head injured patient.

I also try and adjust my vent settings to match the patient's condition, and/ or paralysis/ non- paralysis. Hope this helps, jteeters.
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Thank you for that. I greatly appreciate it. I'm always happy to learn more.
 
33 y/o complain of diarrhea all day. Reported "more than a hundred times" since this AM. Patient is immunocompromised due to other history and believes he contracted a disease common in Africa due to contaminated drinking water. I asked why he thinks he has it, and he said because he participated in risky sexual behavior that "could have potentially exposed him to oral-fecal-contamination."

Patient had a 102.1* fever and a HR of 150
 
Full arrest. Got pulses back.
 
NPO said:
sexual behavior that "could have potentially exposed him to oral-fecal-contamination."
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Eat da poo poo!!!
 
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:confused:Bah! Twas a fist bump back, gotshirtz001.
 
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