Cite this post as:
Scott Weingart, MD FCCM. Intubated ED Patients are Still Not Receiving Sedation. EMCrit Blog. Published on October 18, 2013. Accessed on October 3rd 2023. Available at [https://emcrit.org/emcrit/tubed-but-not-sedated/ ].
Financial Disclosures:
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.
CME Review
Original Release: October 18, 2013
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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WTF!
Apart from the torture… it is embarrassing.
We must do better.
C
here, here
I had to do a RSI at 8000ft cabin due to agitated acidotic patient. long story but I chose to do a ketamine DSI due to the agitation preventing preox. as part of our CRM for the procedure the flight nurse and I got everything setup including the sedative /analgesic maintenance infusion ready and primed. as the ketamine took effect and we started preox, the nurse got a bit fixated with a fluid pump and I got worried the patient was going to start waking up before we were ready to intubate! So I started the sedative infusion myself and… Read more »
Minh,
this may be a great way to go. simply asking for sedation and analgesia drips before you start the intubation procedure usually guarantees success as well.
Here, here, here…
I am trying to get our hospital Airway checklist to look a little like the one developed by Toby Fogg et al at Royal North Shore –
http://www.airwayregistry.org.au/ed-intubation-checklist-v13.pdf
Note the post-intubation infusions are drawn up prior to intubation. Seems like a simple way to ensure it gets done and started early – put in on your checklist….
if you use one (sorry Minh, couldn’t resist 😉
Casey
it is on the EMCrit Airway Checklist as well. It is a critical component of any intubation checklist.
Minh’s stance is irksome not because I have any doubt he has a good handle on everything needed to perfectly perform airway management. All of us with any experience can get by without the checklist. The checklist is for the learners and other team members to gel and have a multiplication of their potential to help if shit goes bad.
In response to Casey, I dont have many intubations under my belt, however having listened to Mike Winters and Scott’s presentations and having read the referenced studies – I found it incredible (I am talking about our institution here) that not only in ED, but in the setting of ICU there is a gaping hole when it comes to post ETT analgesia and often sedation (!!!) What strikes me the most, even when you suggest/ask about analgesia – often you get the “na-h that’s Ok, don’t worry about it for now” even when there are tears welling up in patient’s… Read more »
LOL
just took screen shot of your latest comment Scott to use in my debate at SMACCGOLD with Tim!
my premise is what you state. Those with experience can manage without checklist for emergency airway interventions.
I totally support the use of checklists for learners and those who only need to occasionally intubate.
and to be honest…well lets say checklists are a good idea in general. But i dont want to give Tim any more ammunition against my debate strategy!
Then give Tim this gem
This is written from the perspective of a flight nurse and ER nurse: In addition to the paralytics at the initial intubation, several times in the hospital and pre-hospital setting I have seen practitioners opt to re-paralyze when patients get agitated or when overbreathing the ventilator rather than rethink their sedation strategy. I recently asked an Intensivist to forego a dose of Nimbex for an intubated hypotensive patient with a respiratory rate of 36 despite fentanyl and midazolam infusions, and I opted instead to use Ketamine with great success. I suppose the moral of the story is to think outside… Read more »
keep fighting my friend
You shared a interesting concept of medicine here- nice read!(:
All too often folks are intubated in the ED and are not given adequate sedation. As a critical care doc, I see this more than I would like to. When I was training the ED guys were usually spot on and the patients came up sedated. I have been traveling for five years and have been in 17 hospital thus gotten admits from 17 ED — large and small hospitals and variance of work is amazing. The issue is that education has gone out the window. Docs are too busy with paperwork, charting, and administrative crap to keep up to… Read more »
yup