Pre-hospital conscious sedation

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vquintessence

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Had a debate come up regarding conscious sedation and musculoskeletal injuries. Is there a time and place within EMS for the pt with a compromised distal circulation, sensation or even motor function? (Leaving joint dislocations & separations aside)

Essentially, you have a pt with a fx showing gross deformity to an extremity. Their CSM is compromised on the affected extremity PRIOR to stabilization. ALS has made the decision to attempt ONCE to correct the deformity AFTER appropriate dosing of fentanyl. Would it not be in the pts best interest to consciously sedate with Versed prior to performing the forseeably painful correction? PRO's/CON's?

Lets leave competent/incompetent providers out of the discussion if possible :)

Also:

For those of you who can perform conscious sedations offline, what is the criteria that has to be met? (particularily interested in hospital protocol). Thanks!
 
As I understand, part of the response to pain, is the tightening of muscles around that area. So it's kind of a vicious positive feedback cycle in fractures and dislocations where the pain causes the muscles to contract, causing movement of the injury, causing more pain, causing more contraction... etc. etc. etc. So I would think that Versed would be helpful not only for the conscious sedation effect, but also for the muscle relaxant effect. Hypothetically, if I personally was attempting a reduction in the field, yes I'd want Versed on board not only for the sedation, but also to relax the muscles so hopefully the reduction would be easier and to break that pain cycle... If that makes sense... As always, if I'm wrong... please point me in the right direction ^_^
 
I agree with giving Versed. For one reason that if something went wrong they won't remember it. :-)
 
A separate protocol for conscious sedation, along with the semantic term itself, should be used with caution.

A good pain management protocol should eleviate any need for it. Fentanyl 2-3 mcg/kg in the adult, along with a benzo if needed, should do it. Personally I view it similar to cardioversion, sedation and analgesia would be nice, but is directed by the individual circumstances.
 
Flight-LP said:
A separate protocol for conscious sedation, along with the semantic term itself, should be used with caution.

A good pain management protocol should eleviate any need for it. Fentanyl 2-3 mcg/kg in the adult, along with a benzo if needed, should do it. Personally I view it similar to cardioversion, sedation and analgesia would be nice, but is directed by the individual circumstances.
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True, a good pain management protocol SHOULD be available and encompass all. But we are not created equal. Here we're limited to either MS 0.1mg/kg to 10 or fentanyl 1mcg/kg to 150. Beyond that we go online. The Med Director for my main service is against the idea of adding Versed to the mix because he believes the synergy between the two is too great and we'd end up snowing our pts. Last I checked, didn't we carry an opioid antagonist?
 
vquintessence said:
True, a good pain management protocol SHOULD be available and encompass all. But we are not created equal. Here we're limited to either MS 0.1mg/kg to 10 or fentanyl 1mcg/kg to 150. Beyond that we go online. The Med Director for my main service is against the idea of adding Versed to the mix because he believes the synergy between the two is too great and we'd end up snowing our pts. Last I checked, didn't we carry an opioid antagonist?
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That is sad............

That viewpoint is the exact old school ignorance that restricts your ability to truly treat a patient.
 
Flight-LP said:
That is sad............

That viewpoint is the exact old school ignorance that restricts your ability to truly treat a patient.
Click to expand...

Right, but that hyperbole was what I was driving at. Saying that the majority of pts and providers should be held back because of some "old school" aka dinosaur providers isn't fair to the pt or system.

Under our old medical director we did such for years without anything adverse. Perhaps a few, but that was a CQI issue and the matters were corrected. What has me curious is the total opposition with the new med director, because he is very cutting edge in most every other aspect.
 
Gah, ignore that, I didn't fully read what you said until I hit submit.
 
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