Several comments about the O2 and sedation (I think I expected this really).
Though this particular scenario is hypothetical it is based on my
observation on what sometimes happens in emergency departments.
Anyway, from others comments:-
Several people suggested Capnography, but this is not available in all
departments (it should be) and is also not always available in a form that
reliably detects flow in a mask (rather than an intubated patient). I
believe there are 2 systems in development to detect this. It is possible on
most capnography machines to disconnect the sampling line from the ETT
connector and tape it into the inside of the mask. This is a bit
heath-robinson, it will detect respiration fairly well but is not accurate
in detecting actual ETCO2 levels.
Rob Cocks suggests that an opiate is not needed for relocation of shoulders.
My experience is that these patients are almost always given an opiate on
arrival as they are in pain then (though we now have started to use
ketorolac for such cases - with success). They usually already have some on
board before you get to thinking about sedation.
Stephen Hughes states that the major problem is loss of the airway - fair
comment. "Automatic detection" of this by Sa02 or capnography will be the
same (until robonurse with the sucker and jaw thrust is developed).
John Chambers always reverses the midazolam with flumazenil. Whilst I would
not do this routinely as I don't think it is needed. In the scenario given
this would have been an excellent idea as Ray McGlone suggested.
At least it created a few comments.
Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
England
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Evidence based Emergency Medicine
http://www.bestbets.org
----- Original Message -----
From: Paul Leonard <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, December 09, 2000 9:41 AM
Subject: Re: O2 post sedation
> You could always use capnography!
>
> Paul Leonard
> Edinburgh
>
> ----- Original Message -----
> From: <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: 08 December 2000 22:40
> Subject: Re: O2 post sedation
>
>
> > In a message dated 08/12/00 20:26:39 GMT, you write:
> >
> > << 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.
> > >>
> > I'm not sure about this, maybe the list does, but didn't a couple of
> > Liverpool SpR's patent a non rebreathe resovoir bag with some kind of
> > attachment that automatically records the respiratory rate
> >
> > Shafique
> > A&E SpR North West Thames
>
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