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I'm coming in on this a bit late (as usual) but I haven't seen ketamine mentioned yet. This is my drug of choice for combative head injuries, drunks or whatever. Quick, clean, long shelf life, cheap & wears off quickly. The concern about raising ICP relates to a small trial on a neuro-surgical ward and wasn't looking at acute trauma cases. I accept it doesn't paralyse and is not true RSI, but I cannot find an anaethetist, not even from BASICS, who is prepared to teach proper RSI to a non-anaethetist! NP tubes are great! Following a chat with Vic Calland we have now equipped with 6mm cuffed tracheostomy tubes to gain real airway control when other methods fail. Best wishes John Apps %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%