It seems the government and other specialties are trying hard to make sedation as difficult as possible in the ED. We must persevere to provide the best procedural sedation for the maximal comfort and safety for our patients. This brief lecture was originally posted on the defunct EMCrit Lecture Site on 8/7/2009.
I’m reposting it here so I can post part II sometime this week.
This episode, Part I, covers general concepts on sedation as well as ketamine and etomidate/fentanyl.
Part II will cover propofol, ketofol, and dexmedetomidine.
Part III, to be done some time in the future, will cover really difficult sedations.
In a separate post, I will place an update I did for EM Practice with my fiance on sedation guidelines.
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{ 2 comments… read them below or add one }
An anonymous reader wrote:
Great podcast !
I have a comment on the procedural sedation talk that was especially good.
We have a long and successful experience using Etomidate for procedural sedation except we usually use Alfentanil instead of Fentanyl to make duration even shorter when needed. Many people bad-mouth Etomidate because of “Myoclonus” . Many studies also cite frequent Myoclonus with it’s use.
We rarely see myoclonus and this is why I think that is so.
In our protocol the nurses are instructed to give it over 90 seconds. In studies I have read there is no mention on how long administration takes so it is probably given much more quickly. In one case of inappropriately getting the etomidate PUSH the patient looked like they were having a grand mal siezure. People should try this approach to be open to using Etomidate for selected short procedures- Cardioversion, Chest tubes, Large abscess (not IVDU). etc.
Keep up the good work.
Part I of the procedural sedation talks is here http://su.pr/26QtKo Part II is coming shortly…
This comment was originally posted on Twitter
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