Propofol

[VFlutter]

I do not think I have ever gone above 100mcg on Propofol. I know our pumps have a hardstop at 200mcg. Admittedly, I am sure a transport environment is much different however even during various procedures a little Fentanyl/Ativan on top does wonders. Propofol infusion syndrome and triglycerides are also a concern.

 

[SeeNoMore]

I agree remi but the dose I was sent with was severely under the effective for for sedation. In the future I will be more aware of the pediatric dosages for drugs that are uncommon in my transfers. We don't have protocols for propofol or any sedatives or paralytics for that matter other than valium. We pretty much have to go by what the sending facility doctor orders. At the end of the day I learned a big lesson in not becoming compliant in continuing my education and keeping knowledge like this fresh in my mind.

Sounds like an awful call. I am glad that you are willing to take the time to improve. That being said, I think there is also a danger in expecting too much sympathy for poor decision making and care. As you well know it can cost our patients dearly. You are also part of a broader system which may need improvement. Was there no better option than a 2 hour transport with a single paramedic who admittedly was not prepared for a complex peds transport? I know that sounds awful and harsh but bear with me. Just like you I have made mistakes and acted without proper information. Like you I have tried to improve. But to be honest there have been times when I found myself lacking in some area and knew full well I could have done a better job preparing or just made a better decision. No one is immune. We all have to be our harshest critics.

And I think anyone involved in transport will attest that you have to stand up for yourself. You may have a MD or RN screaming at you to take a patient who you know full well is not stable, or that you do not have the ability to care for. In some situations you may end up transporting but at least make sure you CYA with a call to medical command / the accepting doc notifying them of the pt's condition , your resources and abilities, and get them to verbalize the cost / benefit of transport in less than ideal conditions vs further attempts at stabilization.

I hope your week goes better.

Best ,