Midazolam - Rapid Sequence Induction and Intubation

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Midazolam - Rapid Sequence Induction and Intubation

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Күн бұрын

Midazolam is a common medication used for induction during rapid sequence induction and intubation. Its rapid onset of action makes it a favorable induction agent in emergent situations.
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Пікірлер: 42

@stephaniewilliams9469 2 жыл бұрын

Poison

@01383094 8 ай бұрын

age is also super relevant for dosing. 14mg iv push is far too much.

@Hudson4426 20 күн бұрын

Worked in an ER for 13 years… never once have we used versed for RSI… not saying it can’t happen.. just that it isn’t common… versed is usually used for the violent psych pt

@DigitalAndInnovation Жыл бұрын

"Commonly" 'used'- to be clear we are talking about how many EMS protocols consider it an induction agent. Look- the argument can be made that enough Versed will snow a patient for a Sux intubation... And the bonus is the slight retrograde, plus anterograde amnesia. One of the oldest anesthesia considerations is: If the patient can't remember it- no matter how traumatic it is in the moment- the anesthesia was successful. However that leaves out 4 other elements of the 5 that are considered just as important. Even though benzodiazapines are GABA-positive allosteric modulators (like barbiturates) they are not one and the same. Thiopental is not only classified as an anesthetic- it also includes the classification of hypnotic. I can not think of any scenario where Midazolam is the go to agent. Sure, if you had nothing but Versed (in terms of induction) and that was the ONLY option- better than paralyzing an awake patient. But it is not appropriate to consider it as a first line induction agent. Just to put this in perspective- In very difficult situations (like cardiac procedures)- a Fentanyl (or analog) induction MAY be acceptable. But it is really only used because other agents are not as hemodynamically stable... and/ or an appropriate med given the situation. This argument has been had time ant time again. Standards change with time- years ago heart surgery would involve anesthesia maintenance (high dose opioids and such) post op. Now- cardiac cases use much less of everything. In summery- unless there is NO OTHER option for “induction” - Versed is not even on the table (given that). Using terms like “commonly” (in an intubation scenario) often suggests that it is acceptable.

@DigitalAndInnovation Жыл бұрын

PS: (Ironically the point also shares the letters PS)- Snowing a patient with versed for a short procedure (such as a femoral nerve block) is very different than paralyzing them.

@heleneestherkamga6297 2 жыл бұрын

A quoi sert midazulam

@mace8704 3 жыл бұрын

Anesthesia here. We rarely versed for rapid sequence intubations. There are much better alternatives. In fact, I work at a level 1 trauma center with hundreds of anesthesia providers, and I’ve never seen anyone use versed at 0.1-0.3 mg/kg for induction.

@medzcool 3 жыл бұрын

I partly agree! I am an ER doc at a level 1 trauma center in NYC and the only providers I’ve seen use versed are the MICU and neurointensivists. But for completeness sake, I’ve included this video in the series because, even though it’s less frequently used, I still see providers use it.

@christiansallee427 3 жыл бұрын

I however needed Versed IV drip for my rapid sequence induction during my brain injury that I was flown to a level 1 trauma center from a level 3 trauma center about 87 miles away, since I am allergic to Propofol , Mod to High doses Ketamine, Etomidate , Precedex ( if Pentobarbital or Sodium Thiopental is not available, however there is not antidote for barb's. )

@awilson72 3 жыл бұрын

I’ll pre medicate with fentanyl/ versed before etomidate. I don’t have a paralytic so shooting the narrow time gap with etomidate alone gets dicey

@bayrealist4176 Жыл бұрын

The doctor shot me with Versed IV 4x in 35 mins because I was refusing treatment, This caused an immediate overdose because I had been drinking the same night, was critical care for 35 mins and Troponin T proteins were also found with testing. I don't see how doctors can force treatment like this on people. Especially when I didn't even need it

@cartergomez5390 2 жыл бұрын

They gave this to senior citizens in the form of a pill at the start of the pandemic.

@drewpeacock7707 Жыл бұрын

Causing the “first wave”……..

@chrispaul7849 Жыл бұрын

and murdered 100s of thousands

@chipmonk12 Жыл бұрын

@@heyguysiguessthatsit438 I suggest you look into midazolam

@heyguysiguessthatsit438 Жыл бұрын

@@chrispaul7849 it's a benzo lol. Oldies get lor or diazapam and take it all the time. It's the exact same stuff, but midaz duration of action is lot shorter so other benzos are way worse by your dumb logic

@max81010 5 ай бұрын

Bro its a insomnia pill stfu

@Gaetano.94 3 жыл бұрын

Everytime I got versed, it always tasted like an artificial raspberry. I can even taste a saline flush when I get an IV

@heyguysiguessthatsit438 Жыл бұрын

Huh maybe I'll look for that next time i have big seizure

@smj-yg7eq Жыл бұрын

my ems agency carrie’s versed ketamine and etomidate. We don’t carry paralytics . I still get kinda confused on the sequence to use. In paramedic school we were fought to use 5 of versed followed by ketamine.

@telsutton Жыл бұрын

How many did the UK Dept of Health kill with this (in combination with Morphine)? 100,000? More? It's the biggest scandal of all time.

@TheMehukas 6 ай бұрын

Take your feelings out of your discussion and compare the benefits. I understand it raises lots of emotions if you're an addict or post-addict, but still.

@marcelluswilliam7150 Жыл бұрын

It was very interesting

@TachyTutorials 3 жыл бұрын

Awesome Video

@allthingsbegin 3 жыл бұрын

Don't play around with this stuff. During my addiction to opiates and benzos I almost overdosed.

@thippeshksb8208 3 ай бұрын

My age 23 weight 75 my doctor gave 4ml of midazolam but u saying only 0.3ml/kg 🤔

@thundera9834 Жыл бұрын

Atomidate and Ketamine should be your first choice Sedation is not Midazolams first use Followed by Susinycholine , Roc , Vec

@DanielHalomoan 3 жыл бұрын

You use midazolam for RSI? Still a nice video

@ZantherStone 3 жыл бұрын

What do you mean "still"? You say it as if them talking about it for RSI is the downfall of the video. That's it's whole point. People use it for RSI. Often in out-of-hospital settings where pharmacological choices are more limited, like flight medicine, critical care transport, EMS.

@christiansallee427 3 жыл бұрын

@@ZantherStone I agree with you I am allergic to Propofol (causes - Propofol infusion syndrome) , high - moderate dose of Ketamine, Etomidate also I am allergic to all the other common one's causes M. Hyperthermia and other Disorders.

@juliapeterson4736 Жыл бұрын

Is there a sedative that won't cause amnesia?

@becomematrix 10 ай бұрын

I hope not as the reason why you need them is horrible

@juliapeterson4736 10 ай бұрын

Why wouldn't you want to know what happens before you get totally knocked out with anesthesia? The only reason to "sedate" a patient is so doctors, nurses, and techs don't have to deal with them. It forces compliance from the patient.

@becomematrix 10 ай бұрын

@@juliapeterson4736 you mentioned sedative. It’s wishful because the events could be traumatizing and stressful for the person.

@juliapeterson4736 10 ай бұрын

For many, it's traumatizing not to know. Why not control pain instead of causing amnesia?

@PeteHob 4 ай бұрын

Exactly, while midazolam does calm almost every patient, it could never be considered to take the place of any anesthesia. As for the amnesiac properties, I wish these posts would be more specific by stating that it MIGHT prevent a patient from forming new memories of painful or traumatic procedures. I only say that because it has never prevented me from forming new memories about painful invasive procedures. I’m sure it does for some, but don’t assume you can treat the patient however you want and despite them experiencing everything you are doing, they may not remember any of it. My plea to medical providers is to always remember that Midazolam is that the amnesiac wonder drug that you might presume it to be in every instance