NFL player recoverey

[Andrew J Bowman]

Succinylcholine may indeed cause malignant hyperthermia, but you will not
know it until you give it (unless there is a documented history of same
reaction to anesthetics).

You can give succinylcholine to spinal cord pts and burn pts in the acute
phase of their injury. You do not see problems with hyperkalemia until about
3-5 days post injury.

Low cervical cord injuries may need ventilatory support. If they are only
self venting with their diaphragm then they may get fatigued, as opposed to
have some intercostal muscle function with a degree of thoracic level
injury.

Andrew


On 9/14/07, Roy Danks <roydanks at hotmail.com> wrote:
>
> I think you have your meds confused.  With some anesthetics we worry about
> malignant HYPERthermia.  Succinylcholine is not one (I don't think, but I'm
> not in anesthesia).  But you don't give succs to spinal cord injuries or
> acute burns because of hyper(?)kalemia (Ragnar, et al, you are welcome to
> correct me).  He wouldn't necessarily be intubated if the injury is low
> enough.  Recall that C3-4-5 keep the diaphragm alive.  I think he was C6.
>
> Medical cardiac arrest, traumatic cardiac arrest and acute spinal cord
> injuries are three VERY different animals...I wouldn't get too excited over
> a few saves.
>
> RRD
>
>
>
> > Date: Fri, 14 Sep 2007 13:05:50 -0700> From: fpcems at yahoo.com> To:
> trauma-list at trauma.org> Subject: RE: NFL player recoverey> > I was
> watching national news last nite, and I guess the hypothermia was started
> bycool IV therapy was started in the ambulance. Whatever happened after
> that, couldnt say. I would assume that this patient would be intubated....I
> have a couple of questions about that. Would Succs be indicated or no, b/c
> of the side effect of maliginant hypothermia? > > I believe a field trial of
> induced hypothermia post cardiac arrest is happening or is going to happen
> with Boston EMS. There is an article about a saved patient and this therapy
> on boston.com. > > dave> > > Roy Danks <roydanks at hotmail.com> wrote:> I
> echo your comments. Sounds great, but as I read the USA Today article, I
> cringed....however did the team physician get the goods to start the therapy
> in the ambulance? How is this covered by the > > > > Nuremberg Code -
> Declaration of Helsinki> > It sounds good. He may walk again...they're doing
> it at a big research facility. But it certainly makes one wonder what would
> be the response if the player's outcome hadn't been so (apparently)
> favorable.> > We work hard to get protocols through IRBs, things like this
> could potentially set us back.> > > > > > > From: KMATTOX at aol.com> Date:
> Thu, 13 Sep 2007 22:10:00 -0400> To: trauma-list at trauma.org> Subject: Re:
> NFL player recoverey> > We each have and will be asked to treat future
> patients with similar > protocols. We MUST be sure that any such treatment
> be via an IRB approved tightly > controled protocol. I have searched and
> searched for OUTCOME data to > support both the continuing use of steroids
> or this new HYPOTHERMIA treatment, > or even early decompression in acute
> spinal cord injury. By outcome, I am > talking about a favorable FUNCTIONAL
> outcome, not the hocus pocus non > functional tiny change reports from the
> several methylprednisolone studies. > > Because we are going to be
> innundated with questions, does anyone know the > exact protocol used in
> Miami and in this patient. Was there a lamenectomy. > Was there local
> hypothermia, what drugs were used. Were steroids used. > What has been the
> exact functional improvement and in how many patients?> > Even some of the>
> hypothermia in cardiac and stroke patients is marginal. > We are all being
> asked to buy cooling cradles and blankets for regional EMS > mandated
> protocols, with very very marginal , but marketing, information. ONE > MUST
> NOT equate the studies in MI and stroke to cervical spinal cord injury. > >
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