Be a kind medic

[spenac]

GCS of three and unawareness are not mutually exclusive concepts. Many conditions can produce a GCS of three, while the patient may be awake, aware, yet unable to communicate.

Take care,

chbare.

The reason I disagree with his GCS of 3 is there is a response to stimuli in the form of gag reflex.

edited because I reread and woke up.

[fallout]

I would disagree on the grounds that the gag reflex is just that, a reflex. A reflex never involves the brain. The signal travels down one nerve, the afferent nerve, to the spinal cord where the efferent nerve transmits a signal to the affected body part to react. Even while someone is paralyzed, the signals are still being sent through the nervous system. Since the one of the efferent nerves of the gag reflex is the vagus nerve, bradycardia and hypotension are a significant risk in intubation scenarios.

Searching for "gag reflex arc" on google can tell you more as I am not the most knowledge about neurology.

[toutdoors]

Fallout, I feel for you. We carry etomidate as our frontline sedation for RSI, and have versed for the maintenance side of it, if needed. I would have to agree with you on how tough of a deciscion that would have been, but I agree with you in that you were truly between a rock and a hard place. The thing of it is, there were basically two choices to make here: one, paralyze the pt, and intubate, while possibly causing some possible fear in the pt, if there truly is any awareness, OR, let the pt completely quit breathing, and then intubate. I think that in the context of your situation, you acted in the best interest of the pt, and protected the airway when you did.

Maybe the pt did experience some memory of the event, and was mentally traumatized by the event. The question is simple. Are you the one personally responsible for how this situation transpired? No, you are not. You are not the one who made the suicidal pt overdose on a hypnotic, and a narcotic. You are not the one who personally selected your protocols, and the drugs available to you for RSI. So, you need to work with what you have. Here again, I think you acted in the pt's best interest. Now, if this person did suffer some memory of the event, that is truly too bad. But look at it in a slightly positive aspect, it just may be enough for them to reconsider a second suicide attempt due to whatever memory they may have of the event. (If any at all) So, in a sense, you may have saved this person's life 6 months from now, when they reconsider taking all them dang meds at once again.

[firedoc5]

The sedative acts to block memory of the event. You can use many different types depending on patients condition. Seems most common is midazolam (versed), some others are thiopental, ketamine, etomidate, diazepam (valium).

Versed and Valium was my two standbys, Once in awhile we would find Ketamine in a drug box, but for some reason it wasn't stocked regularly. I guess it depended on the pharmacist who did the "reload".