Etomidate should go the route of The Extinct

[jetproppilot]

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YA FEEL ME?

Our anesthesia pillars teach us as residents that etomidate should be considered and utilized as an induction agent when, as I understand it, cutting thru the chase, (ok I'll cut thru the chase)hypotension isn't desirable on induction, (is hypotension ever desirable on induction? Lol) and that etomidate ameliorates one's concern of hypotension on induction. It is touted as a more hemodynamically stable induction agent.

So you're presented with a 66 y/o male, previous CABG 3 years ago, doing well so far, also has hypertension, diabetes type 2, 110 kg, nice looking airway tho, for a laparoscopic cholecystectomy.

My thought process is I'll adjust my propofol induction dose accordingly rather than use etomidate. For several reasons.

Chime in, residents, attendings, and med students (you gotta have Extreme SWAG to post as a med student on this conversation btw, but there's a few of you out there, I know fur sure)

Will you consider etomidate? Why? Why not?

WHATCHA GOT?

 

[sevo85288]

There are very few reasons to ever use etomidate. You can adjust your dose of propofol, use larger doses of Midazolam (which was designed and marketed as an induction drug initially) use a combination, of midaz,fent and inhaltion induction. In a hypotensive trauma pts I give 5mg midaz. 0.4 scoplolamine and sux, seems to work well, especially if very little blood is going to the brain anyway.

 

[jetproppilot]

There are very few reasons to ever use etomidate. You can adjust your dose of propofol, use larger doses of Midazolam (which was designed and marketed as an induction drug initially) use a combination, of midaz,fent and inhaltion induction. In a hypotensive trauma pts I give 5mg midaz. 0.4 scoplolamine and sux, seems to work well, especially if very little blood is going to the brain anyway.

What are the "very few reasons" you would consider using etomidate, Sir?

 

[pgg]

What are the "very few reasons" you would consider using etomidate, Sir?

No propofol in the drawer? 😀

 

[sevoflurane]

Hypotensive occluded left main may get some etomidate.... I wonder what the lawyers would do if you did induce an occluded left main and then went on to vfib and then arrest.

Honestly though, I rarely crack open amidate. And when I do... I often mix in some propofol... 🙄

 

[NotAMD]

Hypotensive occluded left main may get some etomidate.... I wonder what the lawyers would do if you did induce an occluded left main and then went on to vfib and then arrest.

Honestly though, I rarely crack open amidate. And when I do... I often mix in some propofol... 🙄

nothing wrong with using etomidate either. now im not talking about running an infusion or using on someone with adrenal insufficiency, as the b11 hydroxylase inhibition is real, but no study has shown changes in mortality after one dose, and most of these patients end up getting steroids anyhow or you can just give steroids afterwards. the myoclonus might freak people out who are unfamiliar and think they are having a sz.

but i do see your point that when compared to propofoland al ittle neo it basically has no advantage and has the disadvantage of adrenal insuficiency potnetially and it the patient is really hypotensive youd just use ketamine or nothing.

 

[deleted126335]

What are the "very few reasons" you would consider using etomidate, Sir?

Failing myocardium or significant hypovolemia. Still reasonable. May not be optimal but still reasonable.

 

[Yo GabbaPentin]

What are the "very few reasons" you would consider using etomidate, Sir?

One circumstance I would use etomidate would be.... the oral boards. I would use it frequently on the oral boards.

 

[Intubate]

but no study has shown changes in mortality after one dose.

This is just not true. If fact there are several studies that show just this. They may not be the best studies, and there are definitely studies that don't show this effect. I do try avoid using it in sepsis.

 

[michigangirl]

16 year old most likely significant head trauma rolls into ED trauma bay post MVC. No propofol down there and you didn't bring yours-- too long to go get it or have someone bring it. thiopental is extinct, GCS is 8, normotensive for now. what are ya gonna use?

I say etomidate. i know some peeps poo poo the ICP increase with ketamine issue, but the studies just aren't good enough yet. Etomidate is my friend here.

 

[sevoflurane]

Etomidate and fatal outcome—even a single bolus dose may be detrimental for some patients:

http://bja.oxfordjournals.org/content/97/1/116.full

Patients who received etomidate did have a higher severity of illness, but after correction for severity of illness there is still an increased mortality associated with etomidate administration in one of our models. Importantly, hydrocortisone administration had no effect on outcome in these patients, and therefore the use of hydrocortisone to treat etomidate adrenal insuffi- ciency should be reevaluated. These data raise serious concerns about the use of etomidate in cases of septic shock. We recommend that clinicians demonstrate extreme caution in the use of etomidate in critically ill patients with septic shock because of its association with an IRC and risk of increased mortality.

http://d.yimg.com/kq/groups/16749867/1305607145/name/The+effects+of+etomidate+on+adrenal.pdf

 

[sevoflurane]

16 year old most likely significant head trauma rolls into ED trauma bay post MVC. No propofol down there and you didn't bring yours-- too long to go get it or have someone bring it. thiopental is extinct, GCS is 8, normotensive for now. what are ya gonna use?

I say etomidate. i know some peeps poo poo the ICP increase with ketamine issue, but the studies just aren't good enough yet. Etomidate is my friend here.

Transient... (like sux) when given in small amounts (<.5mg/kg).... a little bit goes a long way with a GCS of 8.

You could also do the versed, alfentanyl, roc thing. 🙄

Etomidate is all good when you don't have anything else. 👍

 

[sevoflurane]

For those that poo poo ketamine....😀

http://www.ncbi.nlm.nih.gov/pubmed/19569909

Conclusion: In ventilation-treated patients with intracranial hypertension, ketamine effectively decreased ICP and prevented untoward ICP elevations during potentially distressing interventions, without lowering blood pressure and CPP. These results refute the notion that ketamine increases ICP. Ketamine is a safe and effective drug for patients with traumatic brain injury and intracranial hypertension, and it can possibly be used safely in trauma emergency situations.

80 some patients....

 

[Frank Rizzo]

No propofol in the drawer? 😀

Exactly why etomidate shouldn't become extinct. With rolling shortages of pentothal, brevital, etomidate, and propofol over the past couple years, i would like to keep my options open.

 

[psychbender]

What are the "very few reasons" you would consider using etomidate, Sir?

When you are playing a game with the attending that you cannot use the same drug on two different patients.

I am just a CA1, and have not used etomidate extensively, but on the occasions where I have used it, I have not seen that it bought me anything that a gentle induction with propofol +/- phenylephrine could also achieve. I have, however, seen some rather scary myoclonus and hypotension when giving a 0.3mg/kg bolus to a mostly healthy (HTN controlled on single agent) middle-aged man. I will probably continue to use it when I can, mostly so that I am comfortable with its administration in the event that I have a patient who is very hypovolemic, has decompensated CHF, or I don't have propofol available (though, can still use the propofol/phenylephrine induction for the first two).

 

[guitarguy09]

I also think that some who is at risk of being hypotensive, from hypovolemia or some other reason, and has significant valvular disease (AS, etc) it should still be considered. There are always other drugs you can use but midaz, fent, etomidate is a possible straight-forward combo.

 

[sevoflurane]

so is midaz, fent and a little popofol.... 😉

(ketamine may be substituted for porpofol if so desired)

 

[halflife94]

When you are playing a game with the attending that you cannot use the same drug on two different patients.

I am just a CA1, and have not used etomidate extensively, but on the occasions where I have used it, I have not seen that it bought me anything that a gentle induction with propofol +/- phenylephrine could also achieve. I have, however, seen some rather scary myoclonus and hypotension when giving a 0.3mg/kg bolus to a mostly healthy (HTN controlled on single agent) middle-aged man. I will probably continue to use it when I can, mostly so that I am comfortable with its administration in the event that I have a patient who is very hypovolemic, has decompensated CHF, or I don't have propofol available (though, can still use the propofol/phenylephrine induction for the first two).

Haven't you guys heard with have a national shortage of phenylephrine now haha

 

[nap$ter]

What are the "very few reasons" you would consider using etomidate, Sir?

judicious use of propofol and phenylephrine will do the trick for most sicksters.

however, i do maintain that etomidate still has a place in anesthesia - used it once last month.

if the pt is close to a DEATH SPIRAL with induction, I consider it. ie aortic stenosis, active ischemia, or real pulmonary hypertension.

minor factors influencing to my decision to use etomidate include rapidity of induction needed, rapidity of case and/or wake-up desired, and presence of ACE-I's (when neo might not be so effective).

for example - the pt i used it on last week: 62yo wheelchair bound 400 pounder c diabetic venous insufficient foot infection for BKA. on antibiotics for a cuppla days. pmh: "rate controlled" flutter, ischemic CHF EF 30% (stented in the past, no current CP), pHTN PaSp 60's, COPD, IDDM, GERD controlled on ppi, OSA on CPAP, panic disorder and chronic pain on mscontin and clonazepam at home.

his case was cancelled in the morning - HR went to 140 when they sat him up for his spinal - sent back to medicine floor for "rate control". medicine loaded him with more dilt and metoprolol, sent him back in the afternoon.

we sit him up on the table for his spinal, HR goes to 140, give 5 of metoprolol, HR back to 100, didn't even try sedation with his history/tolerances. resident and i take a cuppla passes at the spinal, but he arches his back in the wrong direction despite sweet lullabies and hand stroking. preop he declined any other regional techniques.

so to sleep he goes. cuff wasn't reliable on his gelatinous cone of an arm with flutter, so pre-induction aline - sbp 90's - and he's anxious, HR still 100. used ETOMIDATE 16mg, roc 50mg, ezmv, dlx1, ett secured. BP goes from 90 to 80, HR stays at 100. we turn on a wee bit of gas, BP dips to 70's. Phenylephrine doesn't work - vasopressin brings pressure back to baseline nicely (on lisinopril).

this is the kinda guy i reserve etomidate for. lotsa ways to skin this kitty, but IMO etomidate was the best for him.

woulda taken a LOT of propofol to get him to sleep, was dubious that phenylephrine would have much effect, and the response to vasopressin is VARIABLE. Some folks shoot their BP up with 0.5 units, some need 2units. Induction in a patient threatening a death spiral is not the time to test response to pressors.

with his tolerance woulda taken a lotta midaz/fentanyl/scop to get him to sleep, and we wanted rapid control of his airway - and I wanted him fully awake after his BKA. not a good ketamine candidate.

i like to add phenylephrine to my propofol for the sicksters (judicious use is key) - but sometimes, every once in a while, rarely, i still do use etomidate.

 

[dhb]

YA FEEL ME?

WHATCHA GOT?

This might change your mind: "Anesthesiology. 2009 Aug;111(2):240-9.
Methoxycarbonyl-etomidate: a novel rapidly metabolized and ultra-short-acting etomidate analogue that does not produce prolonged adrenocortical suppression."

Cotten JF, Husain SS, Forman SA, Miller KW, Kelly EW, Nguyen HH, Raines DE.

They also developed a carboetomidate that doesn't affect surrenal function.

 

[dhb]

Will you consider etomidate? Why? Why not?

Well if i feel OPEN MINDED i'll use etomidate and slap a BIS on his forehead

I don't use it very often but i don't have a big dilemma with it either: to those in the business it can seem an inferior induction agent compared to propofol but the reality is that no one is looking and the end result is what counts.
Supplement with steroids for 24h id you think the patient will need it.

 

[IN2B8R]

Jet: I was trained by the guy in the following clip http://youtu.be/-vHT6b7u1_Y
He told me to NEVER use Vomidate. For years now, I dare not double cross him...

YA FEEL ME?

Our anesthesia pillars teach us as residents that etomidate should be considered and utilized as an induction agent when, as I understand it, cutting thru the chase, (ok I'll cut thru the chase)hypotension isn't desirable on induction, (is hypotension ever desirable on induction? Lol) and that etomidate ameliorates one's concern of hypotension on induction. It is touted as a more hemodynamically stable induction agent.

So you're presented with a 66 y/o male, previous CABG 3 years ago, doing well so far, also has hypertension, diabetes type 2, 110 kg, nice looking airway tho, for a laparoscopic cholecystectomy.

My thought process is I'll adjust my propofol induction dose accordingly rather than use etomidate. For several reasons.

Chime in, residents, attendings, and med students (you gotta have Extreme SWAG to post as a med student on this conversation btw, but there's a few of you out there, I know fur sure)

Will you consider etomidate? Why? Why not?

WHATCHA GOT?

 

[jetproppilot]

One circumstance I would use etomidate would be.... the oral boards. I would use it frequently on the oral boards.

HAHAHAHAHAHA!

Fabulous answer!

Also loved pgg's, and psychbender's attending game just to name a few.

What I like most about threads like this is how we can turn education into a non painful experience.

 

[Lightwand]

I hate etomidate, but end up using it on almost every non-OR intubation I do while carrying the airway pager. Which is unfortunate considering how many of these patients are septic, or headed quickly down that road.

At our institution, most of us don't paralyze out on the floors/ICUs, which really sucks when the patients clamp down their jaw and sends everyone scrambling to find some paralytic. (Which I why I usually carry a stick of Sux in my pocket). I much prefer prop+neo for out of the OR.

Inside the OR, I'd rather use almost anything else.

There's definitely a place for etomidate, but, yuck.

 

[Hamhock]

I'll throw another time for etomidate out there (realizing I am putting myself exposed for a beating, being a visitor and not have the same level of induction pharm as many of you):

- septic shock and/or cardiogenic shock in the ED

Frequently we are forced to RSI very soon after presentation with minimal knowledge of PMHx or recent HPI. When forced to RSI in these situations (septic and cardiogenic shock in the ED) AND taking into account the long delay for phenylephrine, other adjuncts, or alternative induction agents (only recently ketamine and rocurronium produced any look from nurse other than 😕) to be produced by nurses who only are prepared for 100 sux - 20 etomidate (regardless of patient condition, disease, or weight), I think etomidate is a great choice.

Yes, etomidate is used too frequently, but to call for it's extinction from the ED (and many critical care units), I think would be a mistake.

[[I hope I have not derailed the discussion, if it was meant only for OR settings]]

HH

 

[OB1🤙]

I use etomidate for nearly all cardiac inductions, per institutional culture. I look forward to not having to do this all the time once I'm done with fellowship, because I hate etomidate with the fire of a thousand suns. Outside of the heart room, almost never.

I'd be curious as to what other non-etomidate cocktails are being used out there for induction for something like an AVR/CABG.

My preferred "hemodynamically stable" induction for non-cardiac cases is ~100mg propofol followed by ~100mg ketamine. Less for the elderly. Great for floor intubations too, though less is often required.

Ketamine is way, way underutilized IMO.

I avoid etomidate like the plague in anyone who is septic or at risk for becoming septic.

 

[jetproppilot]

I'll throw another time for etomidate out there (realizing I am putting myself exposed for a beating, being a visitor and not have the same level of induction pharm as many of you):

- septic shock and/or cardiogenic shock in the ED

Frequently we are forced to RSI very soon after presentation with minimal knowledge of PMHx or recent HPI. When forced to RSI in these situations (septic and cardiogenic shock in the ED) AND taking into account the long delay for phenylephrine, other adjuncts, or alternative induction agents (only recently ketamine and rocurronium produced any look from nurse other than 😕) to be produced by nurses who only are prepared for 100 sux - 20 etomidate (regardless of patient condition, disease, or weight), I think etomidate is a great choice.

Yes, etomidate is used too frequently, but to call for it's extinction from the ED (and many critical care units), I think would be a mistake.

[[I hope I have not derailed the discussion, if it was meant only for OR settings]]

HH

You've derailed nothing.

Here's how I liked (notice the past tense but thats another conversation) to prepare patients outta the OR for an intubation...

SMOKE' EM WITH MIDAZOLAM.

Not exactly SMOKEM tho...it's incremental...

incremental doesnt mean it takes a long time either...cuppla minutes..

Rule number one:

Have a free flowing IV. When you're administering drugs in a dire situation nothing is more frustrating than pushing s h it thru an IV on a pump, which is the norm when you're outside the operating room.

Before you start, announce

"I need a free flowing IV, please. Can summbody help me with that?

That'll ensure you don't haffta worry about your drugs actually working after you squirt'em in, and you don't haffta worry about you or someone else flushing the drugs in after administration.

Now that you've got a free flowing IV,

...midaz 2mg....

watch the patient....sleepy? No? Thirty seconds later

....midaz 2mg...sleepy? Probably.

If not, give the other milligram, which you have left, since you had/asked for the 5mg/mL midaz....then

40-60 mg succinylcholine.

I don't get the idea that relaxant shouldnt be used...

Jet thinks sux should be used in very small doses for EVERY offsite emergent intubation (unless contraindicated). It makes your life easier. It gives you a better shot at getting the tube in. It will wear off likkity split assuming you used just 20-60 mg. One could argue it is SAFER for the patient, because of all I just mentioned.

Midazolam in increments.

Sux every time (almost).

IMHO.

 

[dillpickles]

Jet, I might be missing the obvious, but what is the drawback of using 60-120 mg of succ as opposed to 40-60 mg (unless contraindicated) for on-the-floor intubations?

 

[jetproppilot]

Jet, I might be missing the obvious, but what is the drawback of using 60-120 mg of succ as opposed to 40-60 mg (unless contraindicated) for on-the-floor intubations?

Nothing really, dude.

But if you are trying to make an argument to people (residents, who are guided/dictated to by their attendings and or Chair) that can't/won't give ANY PARALYTICS IF YOU'RE IN THE ICU OR ER OR PARKING LOT OR WHEREVER, TRYING TO CONVINCE THEM THAT ONE CAN USE PARALYSIS OUTSIDE OF THE OR, AND CAN USE IT SAFELY,

the less you give, the quicker it goes away. Simple sux kinetics.

I can argue that one can give 40-60mg sux every time and even that small of dose will open a window for you...a small window, yes, but a window nonetheless to your best view. Giving that small of dose, should something go awry, the patient's respiratory drive won't be gone for long.

In other words, the more you give, the longer it is until they breathe on their own again.

 

[Idiopathic]

its been pretty clearly described that no sux = bad, some sux = good, more sux = just as good, so I stick with 30-50 mcg/kg when Im out of the OR and Im worried. I got in the habit of not paralyzing as a resident, however, and never got burned, but Ive shifted away from that as an attending.

I use etomidate occasionally for bad hearts and bad vasculopaths. It does still have a place in anesthesia. It is probably okay in septic patients (Chest 2010).

 

[rsgillmd]

its been pretty clearly described that no sux = bad, some sux = good, more sux = just as good, so I stick with 30-50 mcg/kg when Im out of the OR and Im worried. I got in the habit of not paralyzing as a resident, however, and never got burned, but Ive shifted away from that as an attending.

I use etomidate occasionally for bad hearts and bad vasculopaths. It does still have a place in anesthesia. It is probably okay in septic patients (Chest 2010).

I'm assuming you meant to add an extra zero after your dosing.

30 mcg/kg x 70 kg = 2100 mcg = 2.1 mg = too little.

I have don't a floor intubation in a while, but I used to go towards the higher end of your dose range -- usually giving about 40 mg, if I used it. Officially we weren't allowed to use it without an attending present, but nearly all of us did.

 

[Idiopathic]

sorry, yeah i meant 0.3-0.5 mg/kg or around 40mg for most people

 

[mamitch4]

Yes, etomidate is used too frequently, but to call for it's extinction from the ED (and many critical care units), I think would be a mistake.

I think that providers who are more familiar with etomidate using it in the ED/ICU is very appropriate- not to say that that's what I would use in those settings. I'm pretty comfortable titrating inductions meds, and in my hands some midaz/prop/neo +/- fentanyl typically makes for a reasonably stable induction. But people have to use what they are comfortable with...

 

[proman]

sorry, yeah i meant 0.3-0.5 mg/kg or around 40mg for most people

40mg is a huge dose. At that dose, I think etomidate acts like any other induction agent. For the off floor intubations, I usually used 10-14 mg range. I reserve etomidate for the cardiac cripple who needs an RSI or is undergoing a short procedure where I don't want to give my standard 250 mcg of fentanyl and 6-10 mg midazolam. Add in the hypovolemic or otherwise compromised patient too. I don't think I've ever given more than 20mg.

I'm not a fan of tiny dose propofol in the sick hearts. While the phenylephrine keeps the pressure (afterload) high, the cardiac output gets significantly depressed from the negative inotropy.

 

[Idiopathic]

dose is for sux not etomidate

 

[proman]

dose is for sux not etomidate

oh, disregard. But they do make 40 mg vials of etomidate. Never understood that.

 

[pgg]

oh, disregard. But they do make 40 mg vials of etomidate. Never understood that.

It's for procedural sedation in the ER.

pggHamhock

😀 😉

I think that providers who are more familiar with etomidate using it in the ED/ICU is very appropriate- not to say that that's what I would use in those settings. I'm pretty comfortable titrating inductions meds, and in my hands some midaz/prop/neo +/- fentanyl typically makes for a reasonably stable induction. But people have to use what they are comfortable with...

Agreed. I've never seen anyone outside anesthesia dilute phenylephrine to 100 mcg/mL and put it in a syringe with a purple sticker on it for bolus dosing.

In general, they're not doing titrated multi-agent inductions, and they're not in the habit of propping up critically ill patients' BPs with hits of phenylephrine. When the usual non-code MO is ordering a vasopressor on paper, waiting for the pharmacy to tube it up, then watching a pair of nurses spot-check each other's pump programming - then absolutely, etomidate is probably the best induction drug for them to use, single dose adrenal suppression be damned.

 

[Jay K]

I like to have options and if they'll keep manufacturing etomidate that's just fine by me, since we seem to be losing "anesthesia drugs" all the time and others go short continuously.

It's rare that I use etomidate, but I do use it on occasion.

 

[hoyden]

Exactly why etomidate shouldn't become extinct. With rolling shortages of pentothal, brevital, etomidate, and propofol over the past couple years, i would like to keep my options open.

👍

BTW all those shortages are too familiar 😱

I've lived already a life with a shortage of everything and anesthestics - whatever you have 😡

 

[fakin' the funk]

oh, disregard. But they do make 40 mg vials of etomidate. Never understood that.

This is so after your 10-20mg for induction+intubation, you can continue to give small boluses while the ICU nurses blither around trying to find a resident who'll put the order for the propofol or midazolam drip the patient needs into the computer.

Meanwhile, BP is 220/100 since no one realized the combative head-injured patient might need some sedation/analgesia after intubation.

 

[desflurane]

Anyone else think it sad how little evidence based thins thread has become. You won't use a scop patch on patient because it made YOU hurl? That's how crnas practice. Do whatever Tong Gan says:

http://www.thesotos.net/anesthesia/pearls/ponvreview.pdf

 

[pgg]

Anyone else think it sad how little evidence based thins thread has become. You won't use a scop patch on patient because it made YOU hurl? That's how crnas practice. Do whatever Tong Gan says:

http://www.thesotos.net/anesthesia/pearls/ponvreview.pdf

Think you meant this thread.

 

[Hamhock]

It's for procedural sedation in the ER.

pggHamhock

😀

HH

 

[CambieMD]

One circumstance I would use etomidate would be.... the oral boards. I would use it frequently on the oral boards.

Nice response.

Cambie

 

[Idiopathic]

Anyone else think it sad how little evidence based thins thread has become. You won't use a scop patch on patient because it made YOU hurl? That's how crnas practice. Do whatever Tong Gan says:

http://www.thesotos.net/anesthesia/pearls/ponvreview.pdf

yeah but its a thread about preference...we know that etomidate is an acceptable and safe drug for induction of anesthesia or for intubation outside of the OR. it is probably not the optimal drug for all but is probably the perfect drug for some. what else needs to be said?

 

[periopdoc]

This is so after your 10-20mg for induction+intubation, you can continue to give small boluses while the ICU nurses blither around trying to find a resident who'll put the order for the propofol or midazolam drip the patient needs into the computer.

Meanwhile, BP is 220/100 since no one realized the combative head-injured patient might need some sedation/analgesia after intubation.

When I was on airway call in residency, I carried a 100cc bottle of propofol in my airway bag. After intubation I would pull it out and hand it to the ICU/ER RN. This sped me on my way and the nurses sure appreciated it.

- pod

 

[somedumbDO]

really no reason for etomidate. Its been shown in many studies to increase mortality especially in ICU/sepsis situations. Floor: depending on how sick, hypercarbia is a great sedative. but Fent/versed works as well for sick hearts. prop plus neo for vasculopaths. The only time I would use it for ECT when brevital wasn't available.

 

[pgg]

really no reason for etomidate. Its been shown in many studies to increase mortality especially in ICU/sepsis situations. Floor: depending on how sick, hypercarbia is a great sedative. but Fent/versed works as well for sick hearts. prop plus neo for vasculopaths. The only time I would use it for ECT when brevital wasn't available.

I think etomidate is not such a great choice for ECT 3x/week for however many weeks.

 

[fakin' the funk]

When I was on airway call in residency, I carried a 100cc bottle of propofol in my airway bag. After intubation I would pull it out and hand it to the ICU/ER RN. This sped me on my way and the nurses sure appreciated it.

A great idea and sometimes I'll stay by the bedside and give 10mg propofol boluses until the drip shows up.

But to my knowledge, carrying around medications not SPECIFICALLY intended for a single patient is no longer kosher with JCAHO or whoever.

UNLESS those meds are predrawn by pharmacy and provided in sealed breakaway containers (like the way code carts are).

I think most ICU RNs where I'm at would refuse to hang a propofol bottle if I handed it to them. "But DOC, dere is no ORDER!"

 

[pgg]

But to my knowledge, carrying around medications not SPECIFICALLY intended for a single patient is no longer kosher with JCAHO or whoever.

Concealed means concealed ...

I think most ICU RNs where I'm at would refuse to hang a propofol bottle if I handed it to them. "But DOC, dere is no ORDER!"

Write the order then hand it to them. 🙂