Partial Sedation

[Guest guest]

Okay, I'd like the list to engage me in a discussion regarding a recent

conversation offline...

In discussing the conditions under which carrying RSI medications on field medic

units (vs carrying them at a supervisor level, or not carrying them at all)

should be, an interesting topic shot off. In a lot of places and in a lot of

protocols, the combination of Morphine and Valium is used for an attempt at

sedation (not usually for intubating the conscious patient), but this doesn't

have the same effect that paralytics have on the patient with a clenched airway,

or many others for whom RSI is a consideration. Some services I've spoken with

carry Versed or another like agent for chemical sedation of combative and/or

aggressive patients. So, the question of partial RSI came up... and the

discussion of paralyzation vs. true conscious sedation came up: does RSI only

require enough drugs for the placement of a tube, or should paralysis and

hypnosis/amnesics always be used together to avoid traumatizing a patient who is

being intbated " awake " and unable to respond.

Is anyone out there doing " partial RSI, " just giving a neuromuscular blocker

without altering the patients mental status? If so, what's the side of this I'm

not seeing. If not, why not? Did you consider such a regime in your current

RSI protocols?

Note that I'm not coming out as for or against, and I'm not stating which side

I'm on. Also, I'm not suggesting that protocols be written simply because this

list " feels " it's best. So, here's what I'd like to see/find out:

What are the secondary patient considerations for RSI, or for tube placement in

general? Are there patients you routinely experience that meet initial

qualifications for intubation but that you know you can medically manage

otherwise, possibly even avoiding any intubation at all, field or hospital?

Is there case law for malpractice with regards to lack of intubation, and is

there case law for mental trauma (post traumatic stress was mentioned) for

intubating patients without inducing an amnesic or hypnotic state (or having a

truly unconscious patient)?

Is there a case for sedation alone, or for neuromuscular blockade alone?

Mike