Ketamine vs. Etomidate in head trauma with low BP

[IVAN HRONEK]

I guess this is the way we're gonna talk, nonsense and terms like that...feels like a real scientific discussion...not sure if we want to do that.
 
Anyway, the CRASH trial was using 2 g of methylprednisolone, here you'd just be replacing a sall dose that was suppressed by the Etomidate....Ivan



> From: trauma at emergencyunit.com> To: trauma-list at trauma.org> Date: Sun, 5 Aug 2007 08:50:04 +0100> Subject: RE: Ketamine vs. Etomidate in head trauma with low BP> > 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> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/