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10 Comments on "Procedural Sedation – Part I"

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emcrit
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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.

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On the relative wisdom of synchronized cardioversion without sedation – Part IV | Rogue Medic

[…] sedation, so this is not entirely the same as pre-cardioversion sedation. He does cover this in Procedural Sedation – Part I and EMCrit Podcast 29 – Procedural Sedation, Part […]

Mike
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Scott,
Great talk. Here’s my question: I like your idea about the 15 liters Facemask with continous CO2 monitoring. I think that the buffer of oxygen is safe, and I am a total believer in your concept of watching the CO2 – I am amazed that there hasn’t been a national drive to get these everywhere – worked several EDs with none available. (I am currently on a crusade to get this CO2 monitoring in my ED.) What about those patients who are CO2 retainers at baseline, wouldn’t the high flow oxygen prevent their breathing drive. Since I never used these co2 monitors, I wouldnt know how it would play out. theoretically, i would imagine that i would see a climb in their numbers and know why they were becoming goofy. But in summary, how do you manage these COPD patients with CO2 retention who need procedural sedation?

emcrit
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Mike,

These are very high risk patients and probably should be intubated or sedated with an LMA whether that is done by you or by anesthesia depends on your ED.

JAB
Guest

Scott,

Great podcast as always! I’ve become apprehensive about etomidate recently because of 2 instances of myoclonus that made a shoulder reduction and a hip much more difficult than they should have been. Is it a question of fast vs SLOW IV push as a previous reader asked?

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[…] took listening to Scott Weingart’s excellent series on procedural sedation for the “well d’uh” moment to hit me – why the flip are we admitting these […]

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[…] EMCrit procedural sedation Pt 1 […]

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[…] ecco alcuni link interessanti ACEP clinical policy 2011 Procedural Sedation Emedicine Medscape Emcrit Procedural Sedation part I Emcrit Procedural Sedation part II Emcrit Procedural Sedation Guidelines Pediatric Procedural […]

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[…] Scott Weingart on Procedural sedation […]

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[…] Procedural Sedation Part 1, EMCrit, Weingart 2010 […]

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