Cite this post as:
Scott Weingart, MD FCCM. EMCrit Podcast 29 – Procedural Sedation, Part II. EMCrit Blog. Published on August 1, 2010. Accessed on March 22nd 2023. Available at [https://emcrit.org/emcrit/procedural-sedation-part-2/ ].
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
Original Release: August 1, 2010
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Sent by email from a reader:
I enjoyed your sedation talk. A strategy that is used in our burns department for a dressing change is to mix 200 mg of ketamine with 10 mg of midazolam and made up to a volume of 20 ml in 1 syringe. It is then given as a PCA (usually as 1 ml with a lock out of 3 minutes). Seems to work well.
when using Ketofol, is it taking substantially longer for your patients to awaken and discharge as opposed to just Propofol and fentanyl?http://blog.emcrit.org/wp-content/plugins/wp-notcaptcha/lib/vertical_sign.png
It will take on average an additional 10 minutes of monitoring time in my experience. But this is time that the pt is not at risk of airway compromise.
Dr. Weingart, Love the podcast! I have only recently discovered it, and am part way through my catch-up. I believe it is in this podcast you discuss pain elicitation to increase ventilation rate in sedated patients (sorry if it was a different one, I listen to groups of them at a time). Regardless, you stated that pressing between the posterior mandible and the mastoid process can elicit a good pain response to increase ventilation rate without appearing harmful. However, I’m concerned about the fragility of the styloid process, which I believe is being compressed in this maneuver. Is there a… Read more »
Did you ever get to part III? I can’t find it. This is great. ER nurse…it’s annoyingly hard to find anyone in the nursing world to give you a straight but complete answer on anything. It’s awesome to get this all laid out in one place.
I’m going to go back and listen to both of these a couple of times and make my own notes. Thanks for all the info.
This may be a silly question, but is there a video of how you actually combine the propofol, ketamine, and normal saline (if you need to dilute ketamine) all in a single 20cc syringe? I’m a new Jr ER doc in a rural ED, and I’ve asked my senior colleagues what they do, but they don’t really use ketofol. Hope you can help with the hands-on part of how to actually make ketofol. Do you just squirt 10cc propofol, 10cc ketamine+saline into an open 20cc syringe?
Hope you can help!