Traumacology: Debating Resuscitation Medications

Overview

Many patients come and go through our trauma bays, but the goal never changes: Stabilize them, figure out what they need, then do what emergency doctors do best to ensure our patients get there. Our training has taught us to use certain medications in certain situations, and stay away from others when there is high suspicion of specific injuries, but is that supported by the literature?

In this episode, EMRA*Cast host Will Smith, MD, and Kyle Weant, PharmD, BCPS, BCCCP, FCCP, discuss the evidence (or lack thereof) behind some of the most commonly used resuscitation medications.

TAKE-HOME POINTS

• Research is mixed on TXA.
  • It has been shown to be both efficacious and harmful when using it during a resuscitation.
  • It certainly has its place, but we need to figure out where that place is and which patients should actually be receiving it.
• When used at the appropriate dose, ketamine is an incredible drug 
  • Sedation: 0.5 - 1.0 mg/kg IV
  • Analgesia: 0.1 - 0.3 mg/kg (max ~30 mg) IV
  • RSI: 1-2 mg/kg IV
  • Agitation: 3 - 5 mg/kg IM
• If you don’t want to make them trip, put it in a drip! #KetamineForTheWin
• Ketamine does NOT increase ICP, so just use it!
• Pretreating patients prior to intubation isn’t really supported in the literature