EMCrit Podcast 29 – Procedural Sedation, Part II - a podcast by Scott D. Weingart, MD FCCM
from 2010-08-02T00:19:36
It seems the government and other specialties are trying hard to make sedation as difficult as possible in the ED. We must persevere to provide the best procedural sedation to allow maximal comfort and safety for our patients. This continues the discussion started in Part I, where we discussed etomidate, ketamine, and versed/fentanyl. In this podcast, I discuss propofol, ketofol, and dexmedetomidine.
the emcrit procedural sedation chapter has tons of references for all of this
Propofol
great propofol articles:
Ann Emerg Med 2008;52:392-398
Ann Emerg Med. 2007;50:182-187
Start with fentanyl 1-1.5 mcg/kg
Then give propofol 0.5-1 mg/kg
may need additional injections of 0.5 mg/kg
When patient is where you want them, begin the procedure
May need to give additional 20-30 mgs if the patient becomes too light
Burns on injection, you can precede with 20-40 mg of lidocaine to numb the vessels
Ketofol
read more here: (Ann Emerg Med. 2007;49:23-30)
1:1 mix of ketamine and propofol
In 20 ml syringe, place 10 ml of propofol (10 mg/ml)
And 10 ml of ketamine at a concentration of 10 mg/ml
Note: your ketamine may come in a different concentration, if so dilute down to 10 ml of 10 mg/ml
Shake like a martini
Dexmedetomidine
Precede with fentanyl 1 mcg/kg
Start with 0.5-1 mcg/kg over 10 minutes for loading dose
then use an infusion 0f 0.2-1 mcg/kg/hr
Beware in the bradycardic, hypotensive or patients with heart blocks
May need to supplement with 1-2 mg of midazolam
Procedural Sedation Checklist
here it is
Stay tuned for part III coming to you some time in the future.
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