Comments on: EMCrit Podcast 21 – A Bad Sedation Package Leaves your Patient Trapped in a Nightmare http://emcrit.org/podcasts/post-intubation-sedation/ Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Thu, 17 May 2012 06:35:19 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: Sean Marshall http://emcrit.org/podcasts/post-intubation-sedation/#comment-7599 Sean Marshall Wed, 04 Apr 2012 18:18:04 +0000 http://emcrit.org/?p=369#comment-7599 Scott, I'm listening to this podcast for a second time and I think it is very smart. I am wondering if you have any objective criteria of when you are happy with pain control and move on to a sedative. Do you aim for a RASS target with your fentanyl alone? I didn't think RASS would be specific enough for physiologic signs of pain. I notice that there are tools similar to RASS which look at pain specifically such as CPOT but it looks a little less user friendly than RASS and I think using multiple overlapping tools would be cumbersome. I would also like to get your take on Freire AX. Crit Care Med.2002;30(11):2468. It seems to suggest that adding an analgesic infusion tends to commit the patient to increased monitoring and longer ICU stay. I'm not sure I buy this if drugs are titrated to a target. Thanks for all the great info. Cheers, Sean Scott,
I’m listening to this podcast for a second time and I think it is very smart. I am wondering if you have any objective criteria of when you are happy with pain control and move on to a sedative. Do you aim for a RASS target with your fentanyl alone? I didn’t think RASS would be specific enough for physiologic signs of pain. I notice that there are tools similar to RASS which look at pain specifically such as CPOT but it looks a little less user friendly than RASS and I think using multiple overlapping tools would be cumbersome.

I would also like to get your take on Freire AX. Crit Care Med.2002;30(11):2468. It seems to suggest that adding an analgesic infusion tends to commit the patient to increased monitoring and longer ICU stay. I’m not sure I buy this if drugs are titrated to a target.

Thanks for all the great info.
Cheers,
Sean

]]> By: emcrit http://emcrit.org/podcasts/post-intubation-sedation/#comment-692 emcrit Sat, 27 Feb 2010 16:53:02 +0000 http://emcrit.org/?p=369#comment-692 Mohd, Thanks for your comments! ED extubation is a new frontier here in the states as well; hopefully that will change in the next few years. Scott Mohd,

Thanks for your comments! ED extubation is a new frontier here in the states as well; hopefully that will change in the next few years.

Scott

]]> By: Mohd Anizan Aziz http://emcrit.org/podcasts/post-intubation-sedation/#comment-687 Mohd Anizan Aziz Sat, 27 Feb 2010 04:01:45 +0000 http://emcrit.org/?p=369#comment-687 Dear Scott, Very remarkable stuff you did out there sir, I heartily agree with you pertaining to extubating patient in ED. In place where I come from (Malaysia), We are definitely comfortable in intubation, but when it comes to extubation we tend to leave the headache to someone else. One of anest friends made a remark, that you guys are really quick in jamming tube to patient but when it comes to extubation, you leave the mess to us. For your info sir, I tend to believe that not many of ED practioners in this country comfortable with idea of extubation in ED. But If we were given enough training to do so, the trend will be changing. I a great fan of your podcast, and this idea of extubation in ED serves as an opener to me. Marvelous lecture pertaining to the management of post intubation sedation that you are given to us here sir. All the drugs that you have mentioned including the precedex are available in most hospital in this country. Availability in Ed though is another story. I believe, if there are effort to get accustom and to get familiar with the use of the drugs that you have mentioned, god willing it will be made available in ED soon. Cant wait to listen you future podcast. Thank you MOHD Dear Scott,

Very remarkable stuff you did out there sir,

I heartily agree with you pertaining to extubating patient in ED. In place where I come from (Malaysia), We are definitely comfortable in intubation, but when it comes to extubation we tend to leave the headache to someone else. One of anest friends made a remark, that you guys are really quick in jamming tube to patient but when it comes to extubation, you leave the mess to us.

For your info sir, I tend to believe that not many of ED practioners in this country comfortable with idea of extubation in ED.
But If we were given enough training to do so, the trend will be changing.

I a great fan of your podcast, and this idea of extubation in ED serves as an opener to me.

Marvelous lecture pertaining to the management of post intubation sedation that you are given to us here sir. All the drugs that you have mentioned including the precedex are available in most hospital in this country. Availability in Ed though is another story. I believe, if there are effort to get accustom and to get familiar with the use of the drugs that you have mentioned, god willing it will be made available in ED soon.

Cant wait to listen you future podcast.

Thank you

MOHD

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