Etomidate

[tcripp]

For those that have RSI protocols and for those that have etomidate in your tool box:

Have you used this med for other than RSI. If so, what was the scenario?

Edited November 28, 2010 by tcripp

[PCP]

For those that have RSI protocols and for those that have etomidate in your tool box:

Have you used this med for other than RSI. If so, what was the scenario?

sorry for asking but what does RSI stand for and what is etomidate?

[BAYAMedic]

I personally haven't, but did see it used in the ED with Fentanyl for sedation while they set a Radius Fracture

Fireman1037

[ERDoc]

Besides for RSI, I used etomidate a lot for conscious sedation. If a pt needs a painful procedure such as fx/dislocation reduction or a kid needs stitches, I use it to provide moderate to deep sedation. I will generally start with half the intubation dose and titrate from there.

PCP-RSI is Rapid Sequence Intubation. Pts are sedated and paralyzed to allow for a proper intubation.

[Kiwiology]

The idea of ambo's being let loose with etomidate/propofol scares the shit out of me .... we use fentanyl + ketamine in induction dosing for RSI

[ERDoc]

I can't say there is much difference in propofol/etomidate vs ketamine. None of them are paralytics so it is not truly RSI but more pharmacologically assisted intubation.

[tcripp]

Besides for RSI, I used etomidate a lot for conscious sedation. If a pt needs a painful procedure such as fx/dislocation reduction or a kid needs stitches, I use it to provide moderate to deep sedation. I will generally start with half the intubation dose and titrate from there.

Interestingly, I learned about this from an ED physician at a conference this past week. You weren't in Texas by any chance?

I'm trying to see if anyone else has used it in the pre-hospital setting while, at the same time, trying to learn as much as I can about the drug. I ran a scenario by one of my local docs and he said he probably would not approve it for anything other than the sedation as is in our protocols which leads me to futher research to understand his point of view.

[PCP]

Besides for RSI, I used etomidate a lot for conscious sedation. If a pt needs a painful procedure such as fx/dislocation reduction or a kid needs stitches, I use it to provide moderate to deep sedation. I will generally start with half the intubation dose and titrate from there.

PCP-RSI is Rapid Sequence Intubation. Pts are sedated and paralyzed to allow for a proper intubation.

Thx for the information.

That is way beyond my scope of practice and knowledge. when I was doing my clinical at the hospital I was able to maintain the airway of a pt that was given a milky white substance through an IV that would sedate him/her so that they could cardiovert their sinus rythm from being Tachycardic and irregular to back to normal.

It was a great experience to have been able to help out and watch and learn from the ER Dr. and the attending nurse as to what was being done for this pt and why it was being done.

[chbare]

Besides for RSI, I used etomidate a lot for conscious sedation. If a pt needs a painful procedure such as fx/dislocation reduction or a kid needs stitches, I use it to provide moderate to deep sedation. I will generally start with half the intubation dose and titrate from there.

PCP-RSI is Rapid Sequence Intubation. Pts are sedated and paralyzed to allow for a proper intubation.

I have seen it used in the ER on occasion as well. Do you have a preference when dealing with kids. The last ER I worked at had a preference toward ketamine. Aside from monitoring a little longer with ketamine and the "possibility" on an emergence reaction, I have noticed little in the way of outcomes, anecdotally of course.

Take care,

chbare.

[Aussieaid]

One of the reasons Etomidate is controversial in peds and certain subsets of pts (i.e. sepsis) is because of it's adrenal suppression. This can be offset with corticosteroid administration but it is generally not recommended to give multiple doses of it. With our RSI protocol we are not allowed to repeat the dose of Etomidate and have to go to a different sedative if needed. Etomidate is shorter acting than Ketamine which is good in some situations.

The big difference to remember between Etomidate and Ketamine is that Etomidate has NO analgesic properties and should be given in conjunction with a narcotic for painful procedures.

A problem with Ketamine is emergence delirium but it can be offset with a dose of versed given concurrently.

I think because of the adrenal suppression issue as well as the potent analgesic effect I have seen Ketamine used more in the PICU setting. I have personally only seen Etomidate used for RSI.

PCP- the milky white substance you saw was most likely Propofol which is a very short acting hypnotic that also has no analgesic effects. The good thing about it is that it wears off very quickly which is why it is usually given as an infusion unless it is for induction. The bad thing about it is that it can make a pt very hypotensive and in a stimulus rich environment (such as transport) you may have to give higher doses to keep them adequately sedated which increases the hypotension.

Just my rambling middle of the night take on the main differences. There is plenty of literature about them all for more in depth information. There are other pro's and con's for Etomidate versus Ketamine but that can be for another time.

Cheers!