Rapid Dosing of meds in RSI

[Craig Alan Evans]

What are everyone's thoughts on this method of dosing for RSI?

http://craigalanevans.blogspot.com/2012/09/rsi-part-1rapid-dosing-for-rsismlxl.html

 

[Veneficus]

I like it.

The only thing I would change is the small adult weight from 60kg to 70kg.

 

[usalsfyre]

I do something similar. Small adults gets 150mcg of fent and 20mg of etomidate, average 200 and 30, and large 250 and 40. Nearly everyone gets 150mg of sux or 10mg of rocc (simply to facilitate a fast onset) and a 5-10mg chaser of midaz.

I use the syringe idea as well, but I tend to mix my narcs in flushes, so I've got to be a bit careful there.

 

[NYMedic828]

I've done something similar, in my dreams because NYC has garbage protocols.

Fentanyl hasn't been opened once in all of NYC for an actual patient.

 

[Craig Alan Evans]

That's too bad NY. I'm sure you see far more patients that need it than I do.

 

[usalsfyre]

That's too bad NY. I'm sure you see far more patients that need it than I do.

Craig, have y'all switched to etomidate for induction?

 

[Craig Alan Evans]

Yes, we still use versed post intubation but initially it 's Etomidate .3mg/kg

 

[Craig Alan Evans]

Kyle,

We have also started using Ketamine to control combative psychotic patients. Works like a dream. We used to throw buckets of Versed, Benadryl, and Haldol and they took a goo nap later but it never controlled the acute behavior. One dose of Ketamine and they start starring at the walls. It's a life saver.

 

[Aidey]

I do something similar. Small adults gets 150mcg of fent and 20mg of etomidate, average 200 and 30, and large 250 and 40. Nearly everyone gets 150mg of sux or 10mg of rocc (simply to facilitate a fast onset) and a 5-10mg chaser of midaz.

I use the syringe idea as well, but I tend to mix my narcs in flushes, so I've got to be a bit careful there.

Have I ever mentioned how much I hate you? :angry:

 

[Craig Alan Evans]

Don't be bitter!

 

[Aidey]

We've been out of etomidate for months. I can't give fentanyl with versed and Roc is only allowed to be used in patients with absolute contraindications to sux. I'm allowed to hate him

 

[Craig Alan Evans]

LMAO. I concur.

 

[Handsome Robb]

I like it.

No RSI for Nevada paramedics though. Unless you're in the middle of BFE then maybe, mostly what I've seen is Etomidate and a prayer that they don't trismus out.

 

[Craig Alan Evans]

That's too bad NV. Not using a paralytic increases the difficulty of the intubation tremendously.

 

[NomadicMedic]

Our formula is pretty simple. Evey RSI gets 20mg of Etomidate, 2mg/kg of Sux. Up to 100mcg of Fent... Then 0.1mg/kg vec and up to 10mg of versed.

Adults are either 70kg or 100kg. They come in big or small. That makes it simple.

 

[Craig Alan Evans]

Sounds very similar.

 

[NomadicMedic]

Great minds?

 

[NYMedic828]

That's too bad NV. Not using a paralytic increases the difficulty of the intubation tremendously.

Had a patient react to etomidate with trismus 2 weeks ago...

What a waste to even have our "sedation" protocols. We don't have paralytics and the strictness behind our narcotics turns most people off from even attempting to get orders.

Things like this is what keeps EMS a taxi service because "we may as well just go to the hospital and let them do it." Results in us doing well, nothing but being a taxi that takes vitals...

 

[Doczilla]

Kyle,

We have also started using Ketamine to control combative psychotic patients. Works like a dream. We used to throw buckets of Versed, Benadryl, and Haldol and they took a goo nap later but it never controlled the acute behavior. One dose of Ketamine and they start starring at the walls. It's a life saver.

Did we just become best friends?

Wanna do karate in my garage?

 

[Doczilla]

Had a patient react to etomidate with trismus 2 weeks ago...

What a waste to even have our "sedation" protocols. We don't have paralytics and the strictness behind our narcotics turns most people off from even attempting to get orders.

Things like this is what keeps EMS a taxi service because "we may as well just go to the hospital and let them do it." Results in us doing well, nothing but being a taxi that takes vitals...

Lol poor guy. Might as well bring ether to work.