Wednesday, September 12, 2007

Etomidate, the "Wonder Drug"

You guys know that I've been practing for a while. I've seen lots of new drugs come and go. But I'm trying to thik if there's been a drug that has had as much impact on my EM practice than Etomidate!

I love this med! It makes ortho, surgical, cardiac procedures so easy! I swear most shoulders just reduce themselves now! Only caveat is use it with a little Versed. Since I started using Versed with it, I have not had any myoclonic reactions. Anybody else out there loving this drug?


  1. I love it for short term sedation. Quick, easy, with very few adverse hemodynamic effects.

  2. from my ems perspective it's a sweet drug. although there are grumblings about adrenal suppression, no?

  3. Great drug, but I have to give the nod to ketamine.

  4. Why? I think Vitamin K is great, but don't see it as compared to Vit E..Give us your experiences..We'll all learn something from your knowledge...

  5. I love Etomidate. It's fast acting, has a short half life, and given with Versed it's a ear saving drug when you reduce those joints.

    And afterwards, the patient is oblivious as to what happened.

  6. Love it. At the start of my residency, it was all fentanyl/versed, towards the end we had moved completely to propofol. Sometimes ketamine for kids. We wern't allowed to use etomidate for conscious sedation, only rsi, not sure why.

    Since I left, I'm all about the etomidate. They don't go as limp as they do with propofol, so I think reductions are a little tougher, but not having to worry about the bp and airway so much more than makes up for it.

    I was taught not to give ketamine to adults because of the emergence reactions. Is it really an issue?

  7. Have never seen it, but I always use a benzodiazepine with Ketamine..

  8. I drifted away from etomidate due to myoclonus (aggravating while trying to relocate hips), but will start trying it again with versed.

    I have used ketamine on adults without versed, with no apparent emergence reaction. In fact, the worst emergence reaction I saw was ketamine with versed on a 21 y/o male.

  9. My hospital likes morphine and midazolam, but we're trying to divert to ketamine, or even propofol - but the gas passers don't like it. When I worked in the ITU we used a lot of etomidate, but there does seem to be a concern here about it's effects on the adrenals; and I think our teaching / training with respect to methods of sedation / RSI has a way to go before coming out from the 'shadow' of the anaesthetist

  10. I loved plain old Brevital!

    But I have used Etomidate and I think it's a great. Unfortunately, at my current hospital, I am restricted to using Fentanyl/morphine and Versed or Ketamine. I hate the procedural sedation BS.

    Anesthesia doesn't "feel comfortable" with sedation on 'full stomach' patients...but has no better alternatives. Oh, by the way, they also don't want to come to the ER 24/7 either.

    In 3 years here, I have only seen one anesthesiologist....his daughter had a laceration.

    I am trying to get an approved protocol for an array of procedural sedatives including Brevital and Etomidate. I have the literature to support me, but anesthesia "doesn't feel comfortable" discussing the matter until we have capnography in the ED.

    It gets put in every budget, but somehow falls out of the budget if one of the administrative nurses with a clip board (who can't start an IV) needs a new bidet or something important.