intubation presedation

[douch91]

Looking for info on medictions used for sedation prior to intubations either standing orders or med control.

[ERIC W. HOLLENBECK]

Hey douch91,

I'm a profesional Paramedic/Firefighter with a FD in southern Ohio. I see that your looking for some imput on presedation. Well I can tell you what we use and the ups and downs to it.
First seeing as how we are both medics I'm not going to bore you with "BLS B.S."
I'll start from when we intervene.

Our FD protocol reads as follows.
(1)
NT or ET intubations may be attempted on patients who are breathing but are unable to protect their airway. Pts. who are in extreme respiratory distress and are decompensating may be selectively intubated. GO TO #3 BELOW.

(2)
Pts. with suspected head injurt and no conraindications should be given a 1.5 mg/kg
LIDOCAINE bolus and MIDAZOLAM (versed) 1-2 mg., prior to intubation. If Lidocaine jelly is used to lubricate the tube, decrease the dosage by 1/2.

(3)
For Rapid Sequence intubation

* Prior to intubation initiate the procedures as indicated above-pulse ox, I.V.access, available suction, and cardiac monitor.
* MIDAZOLAM 2mg. IVP
* VERCONIUM .08-.1MG/KG
* intubate patient orally
* ATROPINE 0.5MG. IVP, for bradycardia
* MIDAZOLAM 1MG INCREMENTS IVP every ten
minutes for agitation.

I don't know if that will help but if it does, great if not give me a e-mail and I'll will try to be more specific.

My e-mail address is under my profiles.

[This message has been edited by ERIC W. HOLLENBECK (edited 01-16-2001).]

[dousaems]

I currently operate in two states, and there is a significant difference in the schools of thinking. Maryland really does not have any protocols for presedation, although I have used diazepam to get a few people to unclench enough to drop the tube. Not a regular practice in the field for us.
In Pennsylvania, we currently have 5 drugs that we can use for intubation, including versed, succinylcholine, rocuronium, etomidate and ketamine. Basically we have the right drugs for almost every situation from trauma to CVA. We have great protocols, but rarely do we use this.
I have only premedicated twice before tubing a patient. Any patient in extremis will probably not resist too much for the simple fact that they are using all their energy to breathe. I have nasally intubated quite a few that required nothing more than a little lidocaine jelly.
Really depends on how often your people actually intubate, and how aggressive they are.