propofol - page 10
do ya'll push it fo concious sedation?... Read More
Jun 22, '06I've seen one of our CRNA's push it like it was a flush, (with a succ chaser). Generally though in our ED it's the follow up to Versed after an intubation.
Jun 27, '06we usually use versed and a narcotic for cs.propofol is only used for vented pts in my er.the only time i ever pushed it was in icu on vented pts when we were starting a drip.i have never seen propofol used for cs.Last edit by nuangel1 on Jul 4, '06
Jun 28, '06Our hospital policy is that propofol can only be administered to intubated pts. Pushes can only be given by anesthesia staff.
For conscious or moderate sedation used for reduction of fractures or dislocations we use versed alone or with a narcotic. Pts must be on a cardiac monitor with intubation setup at the bs.
Jun 28, '06dumb question........since my icu days were so long ago and we did not use prop drips/occasional boluses.........even if the patient is ventilated are u not concerned about the other overall concerns mentioned, like pt's cardio status, resp status, etc.? that seem to be concernes with the non-vented patient?
anesthesia only give prop in my setting(pacu) and not sure if they use drips in icu and who or how they are managed....and we use versed/fentanyl for conscious sedation in er which i left 2 years ago and i used ketamine once on a ped conscious sedation and it is scary stuff. i think i made the dr give it.:trout:
very informative thread too btw.
Jun 28, '06WE are not permitted to use Propofol for CS, only fentanly and Versed.
I wish we could use it. We used it in the ICUs
Jun 28, '06[quote=FlyingSquirrel]OK, I see that you are one of those types who is incapable of having a productive discussion with someone who thinks or is used to doing things a little differently than you. You assume that I'm cocky and incompetent just because I'm comfortable doing something that you think I shouldn't be? That's a pretty ballsy and closed-minded assertion considering how little you know about me and my experience.
No, I didn't miss that part of the insert. If I based my entire practice on the warnings listed on drug inserts I would never give anything to anybody.
More than one lawyer, more than one medical director, more than one anesthesiologist, and more that one state board of nursing disagrees with your legal interpretation of that statement. I'm not the only non-anesthesiologist in the world who uses propofol and is comfortable with it
on the package insert of phenergan it warns that the pt may have a seizure. if the pt has one, am i lliable for that?
on the package insert of tpa it warns of bleeding. if the pt develops an ich, am i laible for that too?
all drugs have their risks. i have used a lot of diprovan in the er on dislocated shoulders. the drs are too busdy pulling and tugging to watch the airway. all er nurses have acls and are more than competent to recognize airway demise. sure pts may need to be bagged sometimes. but when done properly, a great sat can be maintained, and intubation avoided.
additionally, i teach acls and i always tell my new interns not to panic if they can't intubate the pt. but to NEVER EVER forget to bag the pt properly.
i don't think crnas are the only nurses on earth who can handle a compromised airway. and to say 'well, rns can't intubate' is not a great arguement either. we can't insert guidewires for pacemakers either, but we sure as heck can push lopressor and know when heart blocks require the drs butt to intervene! the same with airway. if we can't recognize apnea and know we then need more intervention from the doc, then we're a pretty pathetic bunch now huh??
Jul 1, '06We use Etomidate often where I work (in the ER) for sedation or quick procedures, but I often hang Propofol to keep patients sedated while on a vent or during a procedure where we don't expect to bring them out of it -rather xfer them to the unit. So I use it often, but not in the CS format..
Jul 7, '06What do you all think of this? November PET CT- lungs clear as a bell... March PET CT- atelectasis ALL LOBES of lungs, developed 4+ pitting edema to extremeties AFTER January Propofol "issue" in MRI? Hmmmm... Now I have to take Aldactone TID to keep the swelling @ bay & wheeze intermittently when lying down... Wonder if that is related to NOT BEING INTUBATED WITH AN ANESTHETIC ADMINISTERED & having to be bagged back? Kinda makes a person think, huh? ONE STRIKE I DID NOT NEED AGAINST ME @ THIS POINT- OR EVER FOR THAT MATTER... Just some FYI in case anyone wonders what the patient might think of being given Propofol w/out intubation... I keep thinking... this was to help me relax...
Jul 8, '06Policies and procedures are in place for a reason. They are put in place to have something to fall back on. In the event of a complication did the nurse follow proper protocol. If she \he did not then he/she is liable for malpractice. You can play russian roulette with etomidate and propofol but remember it only takes once. True you probably could give these meds without incidence all your carreer but you could also give it once and harm a patient and since it is not within protocol to give this as conscious sedation and not within the scope of practice, you can lose your licence and thus career. The bottom line is the CRNA can give it the RN cannot.
Jul 18, '06Great post tridil2000. Well put. I,m sure you will NOT be popular on this thread for long. Hang in there.
Jul 25, '06from panurses.org
pa state looking at info...several articles and sbon position links
hot issue: procedural/conscious sedation-march 2006
procedural/conscious sedation and who is considered a safe practitioner for administering the varying agents has emerged as a somewhat controversial issue across the country. click here to review.
Jul 31, '06hi all do you know something interesting about propofol . Propofol is act on libido and there are incidence when a male patient try to hold and kiss female nurses while coming out of propofol sedation