Wondering what everyone has for SOs or Protocol to treat these patients.  Are we doing enough to protect us and/or our ER staffs when we treat and transport these patients?

 

I am allowed to give up to 10mg Versed IV/IM/IN and repeat it once if needed or can go to Ativan IV/IM instead.  On top of that a liter of NS and passive cooling if hyperthermic.

 

Ativan has been mixed on the results and Versed seems to work very well with 5mg doses for about 20-30 min.   If a patient is cooperative at first I draw up Versed and have the Nasal Atomizer ready until it can be given IV.  Have not given it with the Atomizer yet but, the crews that have had had good temporary results lasting about 10 min max.  Is anyone using Etomidate or Ketamine out there and what are the results?

 

I ask if we are doing enough because the last two I have taken in ended up tearing apart the ER and needing Law Enforcement to help control with injuries to the providers and the patient being RSI'd.  Should we be sedating these patients to the point of controlling airways and then using paralytics along with sedatives, Facilitated intubation with Etomidate or Ketamine and then Vec or Roc to protect the tube with Versed for sedation?

 

The issue of prehospital and hospital providers is becoming an issue and I feel we need to rethink and look at what we are doing.

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I don't know that I would touch anybody who's agitated with ketamine. Benzos are best, as they are with the bulk of agitated pts.

Most users shouldn't need sedation to the point of airway management. That should be an exceptional case.

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