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Articles That May Change Your Practice: Etomidate Versus Ketamine for Intubation

  • Author Footnotes
    a Russell D. MacDonald, MD, MPH, FCFP, FRCPC, DRCPSC, is the former medical director at Ornge Transport Medicine; the current medical director at Toronto Paramedic Services; a professor in the Faculty of Medicine at the University of Toronto; and an attending staff member at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. He can be reached at [email protected]
    Russell D. MacDonald
    Correspondence
    Corresponding author.
    Footnotes
    a Russell D. MacDonald, MD, MPH, FCFP, FRCPC, DRCPSC, is the former medical director at Ornge Transport Medicine; the current medical director at Toronto Paramedic Services; a professor in the Faculty of Medicine at the University of Toronto; and an attending staff member at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. He can be reached at [email protected]
    Affiliations
    Ornge Transport Medicine, Mississauga, Ontario, Canada

    Toronto Paramedic Services, Toronto, Ontario, Canada

    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  • Author Footnotes
    b Kailey C. Winkler, MD, is a resident emergency medicine physician at Vanderbilt University Medical Center in Nashville, TN
    Kailey C. Winkler
    Footnotes
    b Kailey C. Winkler, MD, is a resident emergency medicine physician at Vanderbilt University Medical Center in Nashville, TN
    Affiliations
    Vanderbilt University Medical Center, Nashville, Tennessee, USA
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  • Author Footnotes
    c Aaron J. Lacy, MD, FAWN, is a flight physician at Vanderbilt LifeFlight and an emergency physician and residency instructor at Vanderbilt University Medical Center.
    Aaron J. Lacy
    Footnotes
    c Aaron J. Lacy, MD, FAWN, is a flight physician at Vanderbilt LifeFlight and an emergency physician and residency instructor at Vanderbilt University Medical Center.
    Affiliations
    Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Vanderbilt LifeFlight, Nashville, Tennessee, USA
    Search for articles by this author
  • Author Footnotes
    a Russell D. MacDonald, MD, MPH, FCFP, FRCPC, DRCPSC, is the former medical director at Ornge Transport Medicine; the current medical director at Toronto Paramedic Services; a professor in the Faculty of Medicine at the University of Toronto; and an attending staff member at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. He can be reached at [email protected]
    b Kailey C. Winkler, MD, is a resident emergency medicine physician at Vanderbilt University Medical Center in Nashville, TN
    c Aaron J. Lacy, MD, FAWN, is a flight physician at Vanderbilt LifeFlight and an emergency physician and residency instructor at Vanderbilt University Medical Center.
      A requisite skill of prehospital emergency care is the ability to establish a definitive airway through endotracheal intubation if a patient is unable to adequately oxygenate, ventilate, or protect his or her own airway. In the emergency setting, this is most frequently done through rapid sequence intubation (RSI). RSI is achieved with a bolus of an inducing sedative medication followed rapidly by a paralytic, allowing quick and safe passage of an endotracheal tube through the vocal cords. There are multiple induction agents, and there is debate about which is most ideal from a hemodynamic standpoint. Hemodynamic stability is crucial during RSI because peri-intubation hypotension has been shown to increase mortality. Because prehospital providers are responsible for the initial patient stabilization, it is imperative they select a hemodynamically favorable agent to decrease the risk of hypotension and thus mortality.
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