Is there any other evidence aside from the one study that I know of that suggests etomidate can cause adrenal suppression and thus, increase sepsis risk? We just discussed this with our EM residents and that was the only study which showed this effect and one of our research folks pointed out that the link in even this study was pretty tenuous!
On separate note, good friend who recently served in Afghanistan swears by ketamine. Says it is their go to drug for all major trauma because of its hemodynamic properties and thus, is safe in pts with traumatic shock (same point has been made to be by others who have served in Iraq and Afghanistan). The question I have is: does anyone still ague it shouldn't be used in head trauma? My understanding is that this "myth" has be solidly "de-bunked"!
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> On Oct 18, 2013, at 9:02 AM, Jay Pershad <[log in to unmask]> wrote:
> Hello Marc et al,
> If you have not, I suggest you review this recent guideline from SCCM. It addresses your question with an evidence based approach to severe TBI. Ehud covered a lot of the key aspects of medical management of elevated ICP.
> Pediatr Crit Care Med. 2012 Jan;13 Suppl 1:S1-82. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents
> Tom, I had an opportunity to hear Peter Kochanek from Pittsburgh, the lead author of the working group that published these guidelines. He was a guest speaker at our institution earlier this year. In general, the peds. intensivists disapprove of our use of etomidate. Their concern surrounds the issue of adrenal suppression, particularly since these patients are at high risk for sepsis. Ketamine or propofol (if hemodynamics are normal) may be better options for sedation in these patients.
> Go Cards!!
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