CTURNEY

My husband won't get a vasectomy, he doesn't trust the urologist (Dr. Hardaway) Two local chiropractors who have recently partnered up are Dr. Hurt and Dr. Hollar.

I WORK IN A FAIRLY BUSY EMERGENCY DEPT 43.000 PER YEAR. WE USE CONSCIOUS SEDATION WITH STRICT GUIDELINES INCLUDING DOCUMENTATION EVERY 5 MINUTES OF VS, MEDS, CARDIAC RATE AND RHYTHM, SAO2 AND LOC ACCORDING TO THE RAMSEY SCALE. WE HAVE DISCHARGE CRITERIA BASED ON THE ALDRETE SCALE, PAIN AND NAUSEA CONTROL AND STABLE VS INCLUDING SAO2. WE USE COMBINATIONS OF NARCOTICS AND VERSED AND/OR SUBLIMAZE. ON ANOTHER NOTE WE KEEP A RAPID SEQUENCE INTUBATION KIT IN WHICH WE STOCK ETOMIDATE, VERSED, SUCCINYLCHOLINE AS WELL AS OTHER DRUGS.WE DO NOT USE ETOMIDATE FOR CONSCIOUS SEDATION. WE USED TO HAVE A KETAMINE POLICY BUT WE FOUND IT WAS TOO UNPREDICTABLE. WE HAD PEDIATRIC PATIENTS WHO HAD POST-PROCEDURE STAYS OF 4 HOURS PLUS (IN THE ED) AFTER KETAMINE ADMINISTRATION. SOME OF THE OTHER ROUTES WE HAVE TRIED WITH PED PATIENTS HAVE INCLUDED INTRANASAL VERSED WITH VERY LIMITED SUCCESS.