We alway revers the midazolam with flumazenil
costa bit but saves all the hassle!
JohnC
-----Original Message-----
From: Simon Carley [mailto:[log in to unmask]]
Sent: Saturday, December 09, 2000 9:16 AM
To: [log in to unmask]
Subject: O2 post sedation
A thought along the theme of sedation.
Scenario
You choose to put a dislocated shoulder back using midazolam and morphine.
You have a pulse oximeter (which alarms if SaO2 < 93%), ECG and NIBP for
monitoring during the procedure. The patient has a non-rebreather reservoir
mask on 15L/min O2.
You are successful in putting the shoulder back (with some difficulty and
quite a lot of midazolam) and put a collar and cuff in position.
You note that the patient is a little more sedated than you would like (they
need a fair bit of stimulation to respond). You are aware that there is a
theoretical risk that the patient will become more obtunded as they are no
longer being stimulated by the pain of the dislocated shoulder.
At this point you need to go somewhere else and leave the patient to be
observed by the Staff Nurse on duty in resus (who is looking after 4
patients in the resus area).
Question
Since your major concern is respiratory depression do you leave the O2 mask
on or take it off?
Rationale
If the patient becomes bradypnoeic whilst breathing high flow O2 they will
remain >93% saturated for a long time (whilst their CO2 rises ever higher).
So should we take the O2 mask off and leave the SaO2 alarm to tell us if a
problem is brewing at an early stage? Or do we accept that a bit of
hypoventilation is not that bad and unless they desaturate on O2 we are not
that worried.
NB. I believe the reality of most of our departments is that our nursing
colleagues cannot stand by the bed checking resp rates on a minute by minute
basis.
Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
England
[log in to unmask]
Evidence based Emergency Medicine
http://www.bestbets.org
######################################################################
Attention:
This e-mail is privileged and confidential. If you are not the
intended recipient please delete the message and notify the sender.
Any views or opinions presented are solely those of the author.
######################################################################
|