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Awoken...
Part 1 out of ????
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Man, am i excited about this!! i have a lot of ideas, so i hope things go well, i will try my best to keep posts constant, and that might make me decrease a bit of the quality from the painting but still i will try to keep the quality to the max. Since now thank you i hope you all enjoy it
"Oops, this is 3-IN-One Penetrating Oil. So, while I have it out, do you have any rusty nuts that need loosening?"
Saturday Evening Post - November 17th 1956
Flower shaped painkiller marketed for menstrual pain.
oxycodone/acetaminophen, 10-325mg tablet
You better memorize all of this, booboo!📖
Fellowship Pearl # 3: More Procedural Sedation Tips
Titrate, synergize, anticipate, re-evaluate!
Titrate: when inducing sedation, titrate to effect and monitor for changes in level of consciousness that are consistent with the desired depth of sedation. BE AWARE of the pharmacokinetics of your selected agents, as some will have faster or slower onsets of action, and may have delayed peak effects; higher doses up front can result in over-sedation requiring rescue.
Synergize: in the ED, many of us are used to trying to stick to one or two sedative agents at a time. This is not inherently incorrect, but if you DO start using multiple agents, their combined effect is often greater than the sum of their individual effects, therefore requiring lower doses of each agent when used together than you might have needed individually. Furthermore--the dose-dependent effects of many agents are idiosyncratic (different effects on different patients) and many are actually metabolised faster by younger patients (ex/infants can really burn through propofol!)
Anticipate: you can often avoid using large cumulative doses of sedatives if you time small boluses around big stimuli. This can also help you avoid over-sedating a patient by having a stimulus-sedative mismatch! This does, however, require that you have a good understanding of the procedure that will be done and how painful/stimulating you expect various aspects to be, and the duration of the stimulus.
Re-evaluate: did the patient cry out and withdraw when traction was applied to their fracture? Then you may need more sedation on board! What are the patient’s ABC’s doing? How is the procedure going, and is it likely going to be uncomplicated or have there already been some snags? These are all aspects of the sedation to continually re-evaluate as you monitor the patient and the procedure. Remember: in the ED, a sedation is an elective procedure, therefore it should be possible to terminate at any time for the patient’s safety or best interest. This must be something you discuss with the clinician/service that is performing the procedure, as the clinician providing the sedation needs to be able to call for the safe termination of the procedure.
Punsounded: Head Butt
It’s been a while since I did one of these. Butt I digress. High Elka!
That painkiller did what Hetr’s minion centipeen couldn’t: get into her head.
A bit insensitive of Knock to ass-k about Elka’s implant. Maybe she just wanted to see it for posterior-ity?
I’m surprised Toma got a medkit. Wouldn’t have expected the cheeky Hetr to give him squat.
Hind-sight is 20/20, Elka, but it don’t help if your brain goes south.
Side note: analgesics do come in topical form. So you can indeed get a butt cream painkiller. In case someone kicked your ass.
#ParrotSays !
This cold & flu season, choose 1 dose* to relieve 8 symptoms. It’s true, #ParrotSays
*Refers to maximum dose per intake, always follow label prior to use
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