Regarding Dr. Olson's comments on trauma surgeons restricting RSI sedatives
to a single agent, etomidate, I would note that limiting your choice of
agents for RSI is akin to asking the surgeons to treat every pneumonia with
only one antibiotic. Like all of medicine, there are multiple drugs for
every scenario and no single agent is ideal for every patient. Part of the
expertise of emergency medicine is knowing how to select the best RSI agent
for a given patient.
Having said that, etomidate is not a bad choice. The only real down side
to this agent is that it does induce vomiting and may not be an ideal
choice for patients with possible seizures. Like most RSI agents it is not
approved for children but there is extensive medical literature and
clinical experience supporting its use.
We use propofol (another unapproved agent) for our CNS patients and
ketamine for our respiratory and hypotensive children. We also use
rocuronium as our paralytic.
It should be noted that FDA approval refers only to a manufacturer's
permission to market an indication for a drug. As a clinician you can use
any drug for any indication you feel has a scientific basis. Probably 50%
of the drugs we use have never been specifically approved for use in
Al Sacchetti, M.D.
Our Lady of Lourdes Medical Center
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