SandPitMedic

We carry ondansetron and metoclopramide. I would like to see us replace metoclopramide with Phenergan, and keep the ondansetron.

Over here, if we are going to intubate a patient with pharmacological assistance, we always use a paralytic if the patient has an intact gag reflex. Under normal circumstances we use 0.3 mg/kg Etomidate, morphine or fentanyl if necessary for analgesia (not for sedation), 0.01 mg/kg Vecuronium as a defasciculating agent, and 1.5 mg/kg Succinylcholine for paralysis. After RSI we use 2.5 - 5 mg Midazolam for continued sedation, and 0.1 mg/kg Vecuronium if we need continued paralysis. We also carry Rocuronium as an additional option. I agree with the idea that we should be using the correct medications for the procedure, and never too much of the wrong medications. IMHO using the wrong tool for the job (in this case pushing Midazolam until the gag reflex disappears) is always asking for trouble. With that being said, I have heard of people having good success using Midazolam as a sedative instead of Etomidate, in appropriate doses, and still using a paralytic.

Currently, my transport times are usually no more than 15 minutes. At my last assignment however, our transport times were equal to our response times (we were stationed at the clinic) and could range from 5 minutes to two hours.