Hello Dr. Olson (a.ka. Kevin)
good drug. We also use it on adults with borderline hemodynamic status (such
as little old ladies/guys with CHF and respiratory failure and BP 90-100
I second all of Al Sacchetti's comments including use of Propofol (Diprivan).
Any drug can be uses in a hypotensive patient- just beware of consequences -
loss of adrenergic drive and vasodilation and hypotension. Versed and
thiopental in fractionated (25-50% ) and titrated doses are also an option
when etomidate and ketamine are not available.
References on advantages and controversies regarding etomidate:
1. Pediatric Emergency Committee of ACEP: Rapid Sequence Intubation of the
Pediatric Patient. Ann Emerg Med July 1996;28(1):55-74.
Etomidate issues addressed with references.
2. Bergen JM, Smith DC: A review of etomidate for rapid sequence intubation
in the emergency department. J Emerg Med 1997; 15(2);221-230.
3. Plewa M, King R, Johnson D, et al: Etomidate use during emergency
intubation of trauma patients (letter). Am J Emerg Med Jan1997;
4. Sokolove PE, Price DD: Safety of etomidate for emergency rapid sequence
intubation of pediatric patients (abstract). Ped Emerg Care Aug
Now...go get 'em.
Mike Gerardi, MD
Saint Barnabas Medical Center
p.s to Kevin:
How are you doing, man? Long time no speak.
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