Why not just give some Flumazenil? I don't give it as a routine but I do if
we are short of nursing staff.
Ray McGlone
A&E Lancaster
----- Original Message -----
From: Simon Carley <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, December 08, 2000 8:15 PM
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
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