HellsBells Posted February 26, 2010 Share Posted February 26, 2010 Intubate using 250mcg Fentanyl 7.0 tube. I'm curious Mobey, in the service you are at, do they have an RSI protocol, or RSS only? How did you find the intubation went with just fentanyl, any problems getting a tube? Link to comment Share on other sites More sharing options...
mobey Posted February 26, 2010 Author Share Posted February 26, 2010 I'm curious Mobey, in the service you are at, do they have an RSI protocol, or RSS only? How did you find the intubation went with just fentanyl, any problems getting a tube? They do have RSI. I had Succ drawn up & ready if needed. I stayed away from Versed due to the hypotension and stuck with the rapid push high dose Fentanyl instead. The intubation went pretty well, she definatly bucked a little when I passed the cords, but once the cuff was inflated and we stopped stimulating her, it was all good. Link to comment Share on other sites More sharing options...
HellsBells Posted February 28, 2010 Share Posted February 28, 2010 Yeah, I agree that with the hypotension, its a good idea to stay away from the versed. Did you hold back on the Succ due to concerns over possible Hyperkalemia with the sepsis DD? Glad to hear that the intubation went well. Link to comment Share on other sites More sharing options...
mobey Posted February 28, 2010 Author Share Posted February 28, 2010 Yeah, I agree that with the hypotension, its a good idea to stay away from the versed. Did you hold back on the Succ due to concerns over possible Hyperkalemia with the sepsis DD? Glad to hear that the intubation went well. RSS has to be attempted prior to paralytics in that service........... Prolly not a bad idea anyway. Pretty easy to confirm placement when she is breathing through the tube Link to comment Share on other sites More sharing options...
HellsBells Posted March 1, 2010 Share Posted March 1, 2010 Ah Fair enough, interesting. Link to comment Share on other sites More sharing options...
Kaisu Posted March 1, 2010 Share Posted March 1, 2010 I dont like double IO. Can you tell me why? I would appreciate the education. Link to comment Share on other sites More sharing options...
ccmedoc Posted March 1, 2010 Share Posted March 1, 2010 Can you tell me why? I would appreciate the education. No evidence based reason..probably just personal preference. I am not convinced of the aseptic procedures pre-hospital and I have seen some raging Osteomyelitis in my time...not pretty and very hard to get rid of. I would think that if you have one good IO, why chance another infection and punch two? I have seen it; I have done it...I just dont like it. This would be my chance to look further for an IV line. You can usually find at least one; usually. I think with the newer EZ-IO and such, my mind could change. But I would try to avoid two IO sites if I could, certainly if you are using Illinois needles or similar technique.. Link to comment Share on other sites More sharing options...
Kaisu Posted March 1, 2010 Share Posted March 1, 2010 No evidence based reason..probably just personal preference. I am not convinced of the aseptic procedures pre-hospital and I have seen some raging Osteomyelitis in my time...not pretty and very hard to get rid of. I would think that if you have one good IO, why chance another infection and punch two? I have seen it; I have done it...I just dont like it. This would be my chance to look further for an IV line. You can usually find at least one; usually. I think with the newer EZ-IO and such, my mind could change. But I would try to avoid two IO sites if I could, certainly if you are using Illinois needles or similar technique.. Makes sense. I am very conscious of infection in that technique and will use an I/O as a last resort. Thanks for the reply. Link to comment Share on other sites More sharing options...
mobey Posted March 2, 2010 Author Share Posted March 2, 2010 Makes sense. I am very conscious of infection in that technique and will use an I/O as a last resort. Thanks for the reply. Her husband also stated "She has no immune system" And "She gets regular transfusions". Those 2 phrases made me less than comfortable with IO to start with. Turns out the "Infusions" were IVIg. Link to comment Share on other sites More sharing options...
Kiwiology Posted March 2, 2010 Share Posted March 2, 2010 For hypotensive patients undergoing RSI we use ketamine 1.5mg/kg Link to comment Share on other sites More sharing options...
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