Sedation for Intubation

Foreign.

Let's talk about sedation. For intubation, you have two options now. We've got etomidate and we've got ketamine. They're both excellent drugs and I'm going to give you some, some tips on when you might want to pick one over the other. But really you can use both in all scenarios. Etominate does not lower the blood pressure, so it's fine for those for folks that are hypotensive, but it has to be given intravenously or intraosseous. You cannot give it intramuscularly. It's a really good medicine, very short acting and will wear off after about eight to 10 minutes. So it's really great for short. If you want a short acting sedative, it's a perfect choice. Even in hemodynamic instability, ketamine can be given iv, IO or even im. Now, we don't really have it in the IM dosage in the protocol for intubation, but for EMS captains out there, if you cannot get an IV or an IO for whatever reason.

It will sedate the patient. Obviously, if you give it intramuscularly, ketamine is a better choice than etominate for people who are hypotensive. That's because ketamine, not only will it not lower the pressure, will actually raise the pressure somewhat. In addition, ketamine is a better choice for those who have bronchospasm. And that's because ketamine actually has bronchodilatory effects. When you look at ketamine, you have to think about ketamine as giving two drugs. You're not giving two drugs, but it has properties of a couple different drugs. It's both a sedative, pain killer and epinephrine. Like qualities. What ketamine will do, it will raise the body's level of epinephrine. So epinephrine, as you see in our asthma protocol, is something we give for severe bronchospasm. That's one of the reasons why ketamine will help to cause bronchodilation in severe asthmatics and other bronchospastic diseases. So those are some of the tips you can really use either for either case. I know that our trauma surgeons do prefer that we use etomidate for the head trauma patients, but the literature shows that ketamine is actually acceptable for head trauma. There is some concern about giving ketamine to hypertensive patients because of its ability to raise the blood pressure even further. So if you already have somebody who's very hypertensive, then etomidate may be a better choice in those cases. But other than that the choice is yours. A couple of other areas where etomidate is superior to ketamine would be, say for pregnant patients. Ketamine is contraindicated for our pregnant folks just because we don't know the effects of ketamine on pregnancy. It just hasn't been studied. There's no data on it, so it's best to just stay away from it. The other area where you would want to use etomidate over ketamine is for cardiac patients either because it's an arrhythmia or CHF and it has to do again with the ketamine's epinephrine like effects. You would not want to give epinephrine to a cardiac patient. So don't use ketamine because ketamine has some ability to raise the endogenous or the intra body epinephrine level. So stick with etominate for cardiac cases. So etominate would be superior for pregnancy and cardiac ketamine is superior for bronchospasic diseases and hypotensive patients. Etominate you want to stick to for hypertensive patients and then everybody else. You can pretty much mix in the.