Okay, I like Happy's blog for the most part, we have been in MASSIVE disagreements over the utilization and deployment of PA's, and NP's, but I also for the most part respect his opinion....
HOWEVER, here, I think Happy has lost it.
Trying to assert that giving propofol in a persons bedroom, and leaving 10 minutes after administration to go to the restroom, is similar to administration in an outpatient healthcare setting is just crazy. That is truly, jumping the shark.
I give propofol frequently for shoulder and hip dislocations, fracture reductions, central line placement, chest tube placement, etc. I also use etomidate, versed, and other sedatives/anesthetics. But never, unless I have airway equipment at the ready, including a laryngoscope and ET tube, and never without proper monitoring. In fact, I had to take a course on concious sedation and prove competency prior to being able to use them. Which is a GOOD thing.
These are serious drugs, and one has to have a VERY healthy respect for them. Using them in someone's bedroom is crazy. Using them, and then leaving 10 min in (which, btw, is just about when they will be awakening with propofol) to go the restroom is criminal.
But that's my opinion.
5 comments:
I am glad that at least one professional in the healthcare field is recognizing something wrong with the scene in which Michael Jackson died. For the last month or so that he has been dead, everyone is so caught up in the drama and the media stories that are coming out; yet, there are so many health risks that could/should have been caught and he might still be alive.
Phyasst, You don't provide anesthesia for your patients do you? Usually an Nurse Anesthetist (CRNA) or Anesthesiologist provide MAC anesthesia in ER setting because it would be foolish for the non anesthesia provider to do so. Propofol is an induction drug an should only be administered by the Anesthetist.
Wow, while you're doing a closed reduction you also administer MAC anesthesia and manage the airway. Your good...man. No, damn it...you're really good. All we need is a couple of PAs like you and this health care crisis would be solved. Damn....you're the bomb!
In our ER, The ER providers administer the sedatives. Usually we have two providers, one to administer the sedation and monitor the patients airway, and another to perform the procedure. We also have respiratory available to assist with airway management if needed. In some of the smaller ER's, when there is only one provider, I order the sedation, then with two nurses, one to monitor the patient, the other to administer the drug, you perform the procedure. I have only seen anesthesia come to the ER on very rare occasions. Usually for a prolonged procedure or sedation, such as upper GI endoscopy.
As far as the second comment, of course you cannot do both simultaneously, and I don't believe I stated so in the initial post. But nice ad hom.
Lastly, it depends greatly on the setting. At the tertiary setting I work at, we administer the sedation, OR perform the procedure, but not both. Often, it is another specialty such as Orthopedics performing the reduction, etc.etc. At the Community Hospital I moonlight at, the CRNA will often come in to do the sedation...not always, as if they need an intubation, there is no time to get a CRNA to come in from home, but, often they do.
At the critical access hospital, there is no anesthesia on call, and the family med doc will usually come in, but they often just observe, as the nurses administer the sedation, and perform the monitoring.
You'll note that one of my statements in the OP was:
"and never without proper monitoring."
I certainly never implied, or meant to imply that you can do sedation, monitor the patient, and perform the procedure all simultaneously. THAT would be foolish indeed.
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