Propofol

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I am looking for someone who carries Propofol on their trucks. I am starting a new job and this EMS director has it on the trucks. Anyone using it ? Work well ?
 
Medics i know in Presidio Texas carry it along with a ton of other drugs. They all like it for continued sedation after ketamine or other rsi
 
Continued sedation? Wow. Do they actually hang propofol drips? That would be amazing!
 
lightsandsirens5 said:
Continued sedation? Wow. Do they actually hang propofol drips? That would be amazing!
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Yep they do. They're ten minutes to the airport to wait for fixed wing air or hour and a half to the nearest hospital
 
I don't work on a truck...

But I am very fond of using propofol, I think it works great.
 
There was a very recent time where it was considered for our shop. Medical director approved it, but the pharmacy board would not. Then someone got the bright Idea to just order Etomidate straight from the manufacturer
 
Fair amount if experience with it. It will be in our next update for CCT medics to initiate post-intubation, but not for initial induction.
 
Veneficus said:
I don't work on a truck...

But I am very fond of using propofol, I think it works great.
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We routinely used it with vented/sedated CCT's with standing orders for titration, of course, for when we need to play the hypotension/arousal yo-yo game. Great addition for any department with medium to long txp times, for sure.
 
Not a great med for sedation when there is a lot of hubbub. I hear its great in the ICU, doesn't work so well on a bumpy, loud truck.
 
I work in the ER. We use it post intubation. Works great on most patients but did not work well at all on our bath salt patients.
 
n7lxi said:
Not a great med for sedation when there is a lot of hubbub. I hear its great in the ICU, doesn't work so well on a bumpy, loud truck.
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As long as the patient is tanked up it works well, the problem is usually a slightly hypovolemic patient who has the dose increased for the additional stimuli.
 
n7lxi said:
Not a great med for sedation when there is a lot of hubbub. I hear its great in the ICU, doesn't work so well on a bumpy, loud truck.
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Titration to appropriate doses, while also maintaining good MAPs will achieve adequate sedation. Often I think people ginger their steps in titration, and that goes for most meds.

Used on a ground unit doing hour plus intubated and vented patients without to many issues. Upon arrival at bedside pt. would get a bolus, then appropriate weight based drip, additional bolus dosages or other bolus sedative if needed.
 
Perhaps, in my limited experience with it, my patients weren't appropriately preloaded...
 
I've used it pretty frequently and observed good results inter-facility. Sometimes additional sedatives are required. In the intubated patient, adding fentanyl and addressing pain while bumping down the road is a better strategy than adding lorazepam or midazolam on top. Just my experience.

Overall, I really like propofol.
 
Presidio's a crazy little service with an insane patient load. Those guys are very, very intelligent.
 
18G said:
I've used it pretty frequently and observed good results inter-facility. Sometimes additional sedatives are required. In the intubated patient, adding fentanyl and addressing pain while bumping down the road is a better strategy than adding lorazepam or midazolam on top. Just my experience.

Overall, I really like propofol.
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I agree. I use it a lot on IFTs. I make sure the patient is adqequately volume resuscitated (so many from the small community hospitals are not) and often add an opiate to it, either morphine boluses or a fentanyl drip. If they get really agitated, I'll midazolam boluses as needed.

In my 911 service area, we're never more than 10 minutes from a hospital, so there's really no need for it there.
 
Farmer2DO said:
I agree. I use it a lot on IFTs. I make sure the patient is adqequately volume resuscitated (so many from the small community hospitals are not) and often add an opiate to it, either morphine boluses or a fentanyl drip. If they get really agitated, I'll midazolam boluses as needed.

In my 911 service area, we're never more than 10 minutes from a hospital, so there's really no need for it there.
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one day...

medical directors will figure out you do not need to make a cocktail with propofol, all you have to do is up the dose.
 
Veneficus said:
one day...

medical directors will figure out you do not need to make a cocktail with propofol, all you have to do is up the dose.
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Sure, if they can tolerate it, hemodynamically.

I know we've had this discussion before. As a paramedic with extensive critical care transport experience, my opinion is that an opiate provides better analgesia than high dose propofol. Using 2 agents means you can use less of each agent, thus limiting the side effects.

That's my experience, and it works quite well, bouncing down the road.
 
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