Etomidate

[Blueflightmedic]

Firstly congratulations to all those who responded so magnificently in
Minneapolis. Condolences to the bereaved. The news broke here in the UK
at 1 AM just as I was returning home from dealing with a very nasty
head-on RTC; three serious, 1 died in my hands on scene from massive
haemorrhage - probably ruptured liver. 

Etomidate is rapidly becoming a drug to avoid because of its prolonged
suppressant effect on the adrenal response. We though initially that it
was only infusions that caused the problem but there is now good evidence
that a single induction dose of etomidate causes problems for some days,
and patients with multiple trauma or severe sepsis do not need adrenal
suppression. We scarcely ever use it now.


> *From:* "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
> *To:* "Trauma-List (E-mail)" <trauma-list at trauma.org>
> *Date:* Thu, 2 Aug 2007 07:11:01 +0200
> 
> Hi all
> 
> A query regarding Etomidate: there is a rumour spreading around 
> South Africa that Etomidate has been "black-boxed" by the FDA and 
> this includes a warning to not use it for RSI. I have been unable 
> to confirm this on their website, but maybe I don't have adequate 
> access. Any list member out tere form the USA who can confirm / 
> deny / give the correct details, so we can give clear guidelines - 
> we still use Etomidate for our RSI in NON-SEPTIC patients (i.e. 
> acute trauma).
> 
> My reading of the literature does not support avoiding of Etomidate 
> in trauma, with only one study in head trauma suggesting a possible 
> link.
> 

BFM