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[jean]

hello, i am really curious about this:
1. if there is a patient with a decreased level of consciousness, how can i know if for intubation this patient still needs the induction agent (or even a fentanyl, lidocain) or not ? is it possible if we correlate it with GCS level?

2. Can i know it by checking the absence of eyelid reflex?
and

3. is it possible that a patient needs only some response blunting drug (such as fentanyl or lidocaine iv) without the need of induction agent? thx u

please help answer..sorry for asking lots of questions..i am quiet confuse about this..

warm regards, Jean

[jafo1964]

GCS < 8 requires intubation as below this patient will not be able to protect his airway.

If the patient is unresponsive you dont need anything to intubate .
He will not resist or fight your attempts. But keep all emergency drugs ready and use xylocard to decrease rises in ICP

If he resists then he may need relaxants, usually suxa is used or you could use rocuronium
We do give some form of anaesthesia before giving relaxants

if hemodynamically stable use thiopentone
if unstable use Midazolam + fentanyl or Etomidate

You could try conscious sedation with remifentanyl infusion or dexmedetomidine infusion too.

In emergency intubation one usually does not have time to titrate doses so eyelash reflex may not be mandatory.
Eye lash reflex loss just shows that the patient is just about under, at this level his tracheal and carinal reflexes will still exist and chances of awareness are high

RECOMMENDED READING
miller - intubating the head injured patient in trauma

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