Solu Medrol - What are its uses? How to use?

[Arizonaffcep]

Ok...but that was a very specific one for septic shock Pts...and the conclusion was that either Etomidate or Ketamine should be used due to their lack of hemodynamic effects, when compared to things like Versed. So...even though it did notice that from 4-12 hrs there was transient adrenal issues, the levels still remained the same when measured during a 24 hr period.

In looking up the older thread on etomidate in single dose for RSI, it was also fairly interesting, but not big enough to mean too terribly much I think (18 pts).

http://www.emtcity.com/index.php?showtopic...mp;hl=etomidate

Sorry to hijack the thread.

[chbare]

Again, adrenal suppression is well documented and well known after a single dose of etomidate. Yes, it is transient however. Obviously, the septic shock scenario is of particular importance because these patients may already have pre-existing underlying adrenal problems.

In addition, the conclusion left the loop hole of "Pending the results of prospective trials..." wide open should additional evidence materialize. While, I am still using etomidate, I plan to keep an eye on the evidence as this debate is still ongoing.

Take care,

chbare.

[kevkei]

So, now I wonder how this will all relate to the etomidate, adrenal suppression, "stress dose" with steroid arguments with RSI and septic shock patients? Still up in the air for now.

Take care,

chbare.

I thought adrenal suppression was associated more with continuous or repetative use of Etomidate? I know research has suggested that in single use it may decrease cortisol levels but wasn't thought to be clinically significant. Have you seen anything indicating otherwise (I've been looking and can't find anything) as I'd love to see a reference if it does as we have been discussing it here as well.

I've seen the article from Journal Watch, so in bacteremia I can see the issue, but for RSI in say TBI? Truly and clinically, cortisol can be given at a primary care centre based on lab values. Considering risk vs benefit, what would be viable or preferred alternatives?

Edited March 10, 2009 by kevkei

[chbare]

I thought adrenal suppression was associated more with continuous or repetative use of Etomidate? I know research has suggested that in single use it may decrease cortisol levels but wasn't thought to be clinically significant. Have you seen anything indicating otherwise (I've been looking and can't find anything) as I'd love to see a reference if it does as we have been discussing it here as well.

I've seen the article from Journal Watch, so in bacteremia I can see the issue, but for RSI in say TBI? Truly and clinically, cortisol can be given at a primary care centre based on lab values. Considering risk vs benefit, what would be viable or preferred alternatives?

Again, adrenal suppression has been noted after a single RSI dose of etomidate. While this is rather transient, it does occur. Again, the possibility of harm or evidence of poor outcomes based on this fact is still up for debate. To date, I would say, definitive evidence does not exist. Yes, adrenal suppression is definately associated with continous infusions of etomidate. You are also correct, that some people may consider "stress" dosing specific patients with hydrocortisone after they receive etomidate.

As I stated earlier, I am not pushing to change my current practice; however, I will continue to keep an eye on the current literature.

A viable alternative agent could be Ketamine. Ketamine has some great effects regarding bronchoconstriction and hemodynamic compromise. However, one must be aware of the potential side effects associated with the use of Ketamine. I know in the US, we tend to say Ketamine is the evil enemy of all things head injured; however, some of the studies that demonstrated this had limitations/flaws. In fact, some people argue Ketamine may have neuro-protective benefits.

All in all, I plan to continue using etomidate for it's fast onset (essentially one arm to brain circulation time), hemodynamic stability, and overall safety profile. In spite of the adrenal suppression issues, I have yet to see definitive evidence that proves etomidate harms people or causes bad outcomes (even patients in septic shock).

Take care,

chbare.

[kevkei]

I also have Ketamine available but our MD prefers Etomidate for RSI.

Not trying to stir the pot with you at all as I do agree it is something to consider and be cautious of.

[chbare]

I also have Ketamine available but our MD prefers Etomidate for RSI.

Not trying to stir the pot with you at all as I do agree it is something to consider and be cautious of.

No worries. I think your medical director has taken a good stance. Absolutely nothing wrong with advocating for etomidate. It is an excellent agent for nearly all RSI scenarios. (For now that is.)

Take care,

chbare.

[dallasdame]

We use Kenalog 40 at our clinic for many dermatological disorders. I have also used K-40 for asthma when I worked for a pulmonologist. It takes about 24-48 hours for the medication to really take affect (prob. why you won't see it on an ambulance) but it stays in the system for about 30 days. It's good stuff!