Ketamine vs. Etomidate in head trauma with low BP

[trauma at emergencyunit.com]

What nonsense. Ketamine, like any treatment was never 'meant' for a specific
purpose like a motor car is meant to be driven. Viagra was initially
investigated as an antihypertensive until embarrassed patients mentioned an
interesting side effect.

It is up to the clinician to decide how to use a medication. Would I be
happy to use it on my mother? A question silly to the point of
offensiveness. What I use and recommend is what I sincerely believe to be
best for the clinical scenario presented to me in that person as a result of
my reading and experience. Whether it is my mother, Joe Soap or President
Bush makes no difference. 

Leaving someone with impending tentorial herniation breathing spontaneously
is negligent, and ventilation, a CT to find if it is surgically remediable
and if so mannitol and craniotomy are indicated. Steroids are definitely
contraindicated in any brain injury as shown in the Crash trial. Brain
perfusion will be compromised by the current fad for systolic blood pressure
in 70s but I had that row here over 5 years ago and nobody listened then.

BFM.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Mathias Kalkum
Sent: 04 August 2007 13:15
To: Trauma & Critical Care mailing list
Subject: Re: Ketamine vs. Etomidate in head trauma with low BP


Ivan,

first to say, thank you for sharing all the information with us.

You should be aware that, as you have mentioned, the potential dangers in
the head injured are - among others - hypoxia and hypotension. Thus ketamin
was never ment to allow spontaneous breathing or to replace appropriate
airway management (read: to avoid intubation). It *may* be used as a
potential analgesic in certain situations where one has to make a balanced
decision (such as in entrapped patients) - that's all about it.
> - snip -
> If your mother suffers head trauma and her BP is low are you saying you'll
intubate her with Ketamine instead of Etomidate followed by steroids ?? You
are not going to tremble that she doesn't herniate on you ?? Really ?? -snip
-
>   
You are not serious on that steroids stuff, aren't you?

Mathias
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