What is your ED policy in these circumstances - page 2
I have a few questions that I am looking to see what your ED hospital policy states or what you think 1) If you have a non trauma patient in your ED (Ie a pt who is septic or who overdosed or is... Read More
Feb 24, '09We start the dopa/levo if patient is critical and request the central line. Chances are if you don't, you won't have a line for long and a mess on your hands.
Conscious sedation is conscious sedation..... it's the drug and not the dose. If they are calling it a "fugue state' they are just trying to get out of a consent.
Pedi sedation, depending on what is given (IM Ketamine etc...) we give it (the doc does). It's a risk/benefits issue. There is not reversal agent for Ketamine and you give supportive measures (bag 'em... etc....).
We do give propafol in the ED "procedural"... it is not deep sedation/used to induce general anesthesia. Once again, it is our docs who give it as they must give the bolus and the nurses only the drips.
Hope this Helps!
Feb 25, '09Quote from jessicrn1st er- yes. loved it, nurses gave it.i have a few questions that i am looking to see what your ed hospital policy states or what you think
1) if you have a non trauma patient in your ed (ie a pt who is septic or who overdosed or is in cardiogenic shock) who needs stat dopamine and levophed vasopressors and has at least one good peripheral line do you not start vasopressors peripherally but wait to start a central line (not ej) or do you start the vasopressors first then when the patient blood pressiure is stablized place a central line.
the first er i worked had an unwritten rule: dopamine over 5mcgs needed a central line. 5mcg was ok in a large bore piv. realisically, if the patient is crumping and needs dopamine, we're not going to withhold pressors while we wait for a central line.
2) how often does your doctors immediately revert to concious sedation for healthy toddlers who need minor procedures ie exploring a toe paronnychia without trying less drastic methods first ie digit block. sedation for ct does not count.
i think most of ours tried to do less invasive procedures first. we were lucky at the first er b/c we had child life, and a lot of times they were able to provide enough distraction. that or else we tied them to the papoose board and did it quick!
3) do you still follow conscious sedation policy when you only use a tiny amount versed (1mg for a locked jaw or ct )
if it's only versed, no. when you get two drugs together (in a close amount of time at least) we would consider is sedation.
4) do you use propofol for conscious sedation in the ed for shoulder and hip dislocation. if so who gives it?
2nd er- no. crna's would come down and give it, and i think i can remember it being given once.
Feb 26, '09Dont ever with hold a needed medication while waiting for a central line! Whats going to harm the pt first? As nurses our motto: Do no harm, would be a complet controdiction. As soon as you pop the versed and mix with narcotics its considered conciouse sedation, ive never used propofol for hips or shoulders, my facility uses versed and fentanyl (its an ortho favorite).