Sketchy propofol dosing

[canoehead]

I was assisting with a conscious sedation and wasn't giving the drugs fast enough so the doc took the syringe and injected about 200mg in less than 10 minutes, with 200 Fentanyl and 5 Versed. RT at the bedside. The patient stopped breathing...I was watching and there was no chest movement. He had been well washed out with O2 before the procedure so his sats stayed up. I pointed out the apnea, but both RT and MD noted the great sats and let the apnea continue for a good minute (felt like forever to me).

Are they right that the apnea is fine as long as the sats are good. The brain still oxygenates, but I picturing a build up of CO2 and acidosis, resulting in a frightening situation for the patient. My gut says they were being reckless, but I can't back it up with fact.

[canoehead, BSN, RN]

I would never allow a physician, or anyone else to inject drugs into MY patients. That's not his job, his job is to do the procedure. Sounds to me like what was needed was a more effective patient advocate.

He literally took the syringe from me because I wasn't injecting fast enough. When he injects it he gets to sign it off, not me. So the effects are on his head. I would have refused to continue when resps went below 10, good sats or not. The ortho doc was doing the procedure, and the ER doc was giving meds. Try being the naysayer with 2 docs and an RT saying the patient is just fine. I may have been right, but I wasn't going to win.

When I worked in the US we didn't use propofol without a vent either, but apparently in Canada things are different. I'm much less comfortable than a lot of my coworkers because of the apnea issues, and if I had my druthers we'd do Versed and morphine, and take the extra time for recovery.

Can anyone state long term effects of increased CO2, even when O2 sats are 100%? Assuming the patient starts breathing again and blowing off CO2 within 5 minutes, and the sats remain high, I don't like it, but can I hang my hat on as effects to the patient the next time it happens?

[MassED, BSN, RN]

He literally took the syringe from me because I wasn't injecting fast enough. When he injects it he gets to sign it off, not me. So the effects are on his head. I would have refused to continue when resps went below 10, good sats or not. The ortho doc was doing the procedure, and the ER doc was giving meds. Try being the naysayer with 2 docs and an RT saying the patient is just fine. I may have been right, but I wasn't going to win.

When I worked in the US we didn't use propofol without a vent either, but apparently in Canada things are different. I'm much less comfortable than a lot of my coworkers because of the apnea issues, and if I had my druthers we'd do Versed and morphine, and take the extra time for recovery.

Can anyone state long term effects of increased CO2, even when O2 sats are 100%? Assuming the patient starts breathing again and blowing off CO2 within 5 minutes, and the sats remain high, I don't like it, but can I hang my hat on as effects to the patient the next time it happens?

being in the middle of a few docs and a RT who might argue with you isn't fun. Beyond voicing your concern, there's not much more you can do - without repercussions from that doc (the ER one)... you could write it up, or where I work we have an anonymous form to submit, but still.... the doc would know it was you.... I might speak up, but that doc sounds like a jerk - and since I work with more than a few of those, I would (in the real world) let them do their thing,chart that the doc administered med and prepare to ventilate patient.