February 2019 - Podcast

…Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double-Blind Clinical Trial PMID: [30611640](https://www.ncbi.nlm.nih.gov/pubmed/30611640) DOI: [10.1016/j.annemergmed.2018.11.016](https://doi.org/10.1016/j.annemergmed.2018.11.016) Journal and Year: Annals of Emergency Medicine. 2018. Lead Author: Narjes Akhlaghi Background: – Generally k

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December 2017 - Podcast

…neck and shoulders is probably the worst position. It may promote asphyxia and furthermore cause deterioration of acidosis What about sedation? 3 types of drugs are recommended by the Guideline – Benzodiazepines, antipsychotic and Ketamine. Benzodiazepines currently Lorazepam is recommended by NICE. Risk of very variable effect either ineffective or…

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Post Cardiac Arrest: Care of the ROSC Patient - Reference

…Disability Record the GCS prior to administering any sedation it has implications for prognostication. Be cautious with sedation. If the patient is making inadequate respiratory effort or fighting the ventilator, neuromuscular blockade is necessary to gain control of their ventilation. It then becomes essential to ensure the patient is adequately…

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Pain Management in Adults - Reference

…its brief action, providing analgesia for 30-45 minutes, thereby giving it a role in procedural sedation. Ultra-short acting opiates have been developed such as remifentanil (duration of action <6 minutes) and alfentanil (about 10 minutes). Whilst there are theoretical benefits, you should consider governance and training issues before using them….

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April 2017 - Podcast

…IM route Research nurses observed patients for the 60 minutes (0, 5, 10, 15, 30 and 60 minutes) following administration for the primary outcome of evidence of respiratory depression (multiple criteria) They also observed for: OAA/S Scale (5 point sedation scale) Any monitoring data available Any ECG performed Treating physician’s…

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Acute Alcohol Withdrawal - Reference

…sedation. These patients are at high risk of over sedation and complications and will likely require close observation and one to one nursing care. Other treatments for benzodiazepine refractory AWS have been described in the literature such as phenobarbitoal21,22, dexometamadine23,24and ketamine25however none of these are currently in widespread use in…

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Aug 2016: New in EM - Podcast

…a year in 2014/2015 Intervention Ketamine 5mg/kg was on the ambulances for 6 months of the year Comparison Haloperidol 10mg was on the ambulances for the other 6 months of the year Primary outcome Time to adequate sedation (determined by the paramedic or ED staff) Summary of results 146 patients…

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Shoulder and Brachial Plexus Injury - Reference

…sedation should be in accordance with a locally determined and approved policy with appropriate monitoring. Intra articular local anaesthetic has been reported to be useful9 though when operating on a patient with an acute dislocation it is clear that the injection is often placed erroneously.There are a variety of reduction…

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Acute Behavioural Disturbance - Podcast

…Guidance RCEM Guidance St Emlyns Commentary on same(Chris Gray) Ambulance Victoria CPG Sedation Assessment Tool. Calver 2011 DORM 2 and DORM both showing the utility (and likely safety) of droperidol (shame we dont have it. Other studies also supporting it Nice Blog from Brent at Canadiem.org Recent splurge of ketamine…

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Shoulder and Brachial Plexus - Learning Session

…May 2005. Phillips AM, Smart C, Groom AF. Acromioclavicular dislocation. Conservative or surgical therapy. Clinical orthopaedics & related research 1998:353:10-7. Royal College of Anaesthetists. (Nov 2001) Implementing and ensuring safe sedation practice for healthcare procedures in adults. Miller SL, Cleeman E, Auerback J et al. Comparison of intra-articular lidocaine and…

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