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>>> [log in to unmask] 04/23/01 11:59 >>> >I would never resort to IM ketamine or IM sux for this patient who has to be >assumed to have a major head injury as well. Colin, I don't agree (obviously), the risk of a transient rise in your ICP, which has by no means been clearly shown to be a resl clinical problem with Ketamine, is off set by the fact that this guys hypoxia is rapidly knocking off neurons and I think Ketamine is justified as part of what I see as one of the few practical induction options available to you. >IM Sux (or IV Sux) alone in this setting is not only dangerous but inhumane. I agree that its probably inhumane and I would you a sedative / induction agent, but I wouldnt call it dangerous - anything you do to this guys airway is going to be fairly high risk - what specifically are you worried about here ? The main risk I see is further collapse of the upper airway secondary to loss of muscle tone with paralysis. I think Darren is right, there is clearly 2 schools of thought regarding at what point it becomes acceptable to use muscle relaxation alone - I say hardly ever and never at GCS 7, but there are others around who would for a variety of reasons. Everything that is going on in this situation is going to be pushing his ICP up - he's struggling and he's hypoxic - I dont believe that a crash induction in this situation is going to make things worse and is certainly medically defendable. >What has happened to the primary surgical airway? Certainly its a definite option, but again with GCS 7 and thrashing around your still looking at having to give him something Craig EM registrar, New Zealand CCH Secure Mail Server ******************************************************************************** This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital Coast Health Ltd. (AC_S001) [INFO] -- Virus Manager: No Viruses were detected in this message. ********************************************************************************