Lidocaine for ICP & RSI
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jjesusfreak01
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Any one every pushed lidocaine for ICP from head trauma before pushin SUC and VEC for a RSI...is it worth it. Protocals say do it, most ppl say not worth it and Medical Director says not really worth it either....2 centsh34r: 1.5mg per kg
Do what your medical director says. Anything else is a breach of protocol. Feel free to ask them about it, however. I know we don't do it in my system, but we don't RSI either.
Shishkabob
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Sux AND vec?
Plus, your current location is inappropriate
Plus, your current location is inappropriate
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Yup, we use suxamethonium and vecuronium in combination here.
Shishkabob
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Why? Seems you're getting the negatives of both for no real reason.
I understand vec/roc for post intubation maintenance and sux initially, but not both at same time?
I understand vec/roc for post intubation maintenance and sux initially, but not both at same time?
boingo
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Duplicate threads merged.
usafmedic45
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Trying to avoid fasciculations but still have rapid onset?
Shishkabob
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That's what I was thinking but really, having a few RSIs myself, the time it takes roc to kick in isn't horrible...
usafmedic45
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Personally, I'll just wait for vec to kick in. If time is that much of a factor, there's always the option of a cric.
Smash
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It's not concurrently, vec is only used if long term muscle relaxation is required.
mikie
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Here are two previous threads on this topic:
http://www.emtlife.com/showthread.php?t=9136
http://www.emtlife.com/showthread.php?t=20500
http://www.emtlife.com/showthread.php?t=9136
http://www.emtlife.com/showthread.php?t=20500
Free here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725712/pdf/v018p00453.pdf
Emerg Med J. 2001 Nov;18(6):453-7.
In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature.
Robinson N, Clancy M.
Source
Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. poppabear66@hotmail.com
Abstract
It is well known that laryngeal instrumentation and endotracheal intubation is associated with a marked, transient rise in intracranial pressure (ICP). Patients with head injury requiring endotracheal intubation are considered particularly at risk from this transient rise in ICP as it reduces cerebral perfusion and thus may increase secondary brain injury. The favoured method for securing a definitive airway in this patient group is by rapid sequence intubation (RSI). In the United States the Emergency Airway Course teaches emergency physicians to routinely administer intravenous lidocaine as a pre treatment for RSI in this patient group in an attempt to attenuate this rise in ICP. A literature search was carried out to identify studies in which intravenous lidocaine was used as a pretreatment for RSI in major head injury. Any link to an improved neurological outcome was also sought. Papers identified were appraised in the manner recommended by the evidence based medicine group to ensure validity. There were no studies identified that answered our question directly and, furthermore, it is our belief that no such study, at present, exists in the literature. Six valid papers were found, which individually contained elements of the question posed and these are presented in a narrative and graphic form. There is currently no evidence to support the use of intravenous lidocaine as a pretreatment for RSI in patients with head injury and its use should only occur in clinical trials.
Comment in
Emerg Med J. 2001 Nov;18(6):419.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725712/pdf/v018p00453.pdf
Emerg Med J. 2001 Nov;18(6):453-7.
In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature.
Robinson N, Clancy M.
Source
Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. poppabear66@hotmail.com
Abstract
It is well known that laryngeal instrumentation and endotracheal intubation is associated with a marked, transient rise in intracranial pressure (ICP). Patients with head injury requiring endotracheal intubation are considered particularly at risk from this transient rise in ICP as it reduces cerebral perfusion and thus may increase secondary brain injury. The favoured method for securing a definitive airway in this patient group is by rapid sequence intubation (RSI). In the United States the Emergency Airway Course teaches emergency physicians to routinely administer intravenous lidocaine as a pre treatment for RSI in this patient group in an attempt to attenuate this rise in ICP. A literature search was carried out to identify studies in which intravenous lidocaine was used as a pretreatment for RSI in major head injury. Any link to an improved neurological outcome was also sought. Papers identified were appraised in the manner recommended by the evidence based medicine group to ensure validity. There were no studies identified that answered our question directly and, furthermore, it is our belief that no such study, at present, exists in the literature. Six valid papers were found, which individually contained elements of the question posed and these are presented in a narrative and graphic form. There is currently no evidence to support the use of intravenous lidocaine as a pretreatment for RSI in patients with head injury and its use should only occur in clinical trials.
Comment in
Emerg Med J. 2001 Nov;18(6):419.
8jimi8
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Any one every pushed lidocaine for ICP from head trauma before pushin SUC and VEC for a RSI...is it worth it. Protocals say do it, most ppl say not worth it and Medical Director says not really worth it either....2 cents
Based on what I have read, there is no improvement in outcomes with or without lidocaine. Follow your protocol or suffer the wrath.
I find it kind of amusing that one of the hypothesized mechanisms for the increase in ICP post succs is due to fasciculations of neck muscles impeding venous flow from the cranium, which is also potentially impeded by... a c-collar.
It's probably all a waste of time...
It's probably all a waste of time...
There's a bunch of data showing that c-collars affect ICP. Just not a lot of data showing that this impacts outcomes.
I agree that premedication probably isn't that important.
http://www.ncbi.nlm.nih.gov/pubmed?term=cervical%20collar%20intracranial%20pressure
There's an older literature review on sux and ICP here (free .pdf)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725690/pdf/v018p00373.pdf
A decent free article on pre-medication with atropine in peds here
http://www.cjem-online.ca/sites/default/files/pg114.pdf