----- Original Message -----
From: "Andrew Lockey" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, November 05, 2001 8:31 PM
Subject: Re: Flumazenil, Sedation and Fits
> Not all - those that tend to need sedation are those with associated
avulsed
> tuberosities or those who are already in irretrievable spasm. Once again,
they
> DO get analgesia - entonox. This allows subsequent sedation if required
> without the tricky problem of loading up with morphine and then
effectively
> giving them an uncontrolled GA with the sedation. Entonox seems to be
> underrated and underused (similar to regional nerve blocks).
Entonox does seem to be under rated, as for underused, it is well used but
not a widely as it could be ( the VASes and the midwives go through enough
for their patients).
in the VAS situation ( and for IHCD ambi techs as well ) this is because
it's the only decent analgesia they have available, seems to do it's bit
with fractures, dislocations and severe soft tissue injuries. in all from
what i have seen of it it's good, the quick onset and short duration of
action have their benefits, in theory you cannot overdose on it !
> Also difficult to
> use in the sedated patient, unless delivered through a system without
demand
> valve, i.e. a Boyles machine!!!!!! (or equivalent). Wow - can we link any
more
> threads into this one?
well it depends om the entonox set, the old BOC sets ( with black elephant
tube to the mask and the demand valve joined to the pin index yoke and first
stage regulator) had a control on the demand valve and various of the
moderen sets do as well, which in theory are there to purge the system once
the cylinder is switched off (due to the dangers of removing charged systems
even when the cylinder is switched off ), but could be (mis)used to provide
IPPV with entonox, in the style of a microvent etc.
Martyn Hodson
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Student Nurse Sheffield University
SJA Ambulance Attendant, AED Operator
writing for myself, views expressed are entirely my own,
and may not reflect those of Sheffield University or St. John Ambulance ,
Nationally or locally
-Duct tape is like the force, it has a light side and a dark side,
and it holds the universe together.
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