stabbed heart

[HAXScott at aol.com]

If you RSI'd a kid without appreciable central pulses, what induction agent  
did you use? Ketamine? Agree fully with Ron - even without medications he's  
going to dump when you begin positive pressure ventilation - important not only 
 in this case of cardiac tamponade, but anything that impedes venous return  
(asthma, ptx...) 
 
Nice job to the field guys for not screwing around and not dumping  
crystalloid into him! 
 
Change the scenario now - his stab is more lateral, he has markedly  
diminished breath sounds on the side of the injury, SQA, etc... and he's  combative as 
in this scenario - obviously we'd all prefer the chest tube before  
intubating him, but can you safely (for you and him) accomplish tube  thoracostomy with 
him combative, and is there an alternative approach (eg  Ketamine ALONE) for 
sedation WITHOUT mask ventilating him or intubating him  until after his CT is 
in?
 
 



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