Abordnet

I agree 100% there. What discredits your point, at least in my mind, is the force with which you discredit a training program approved by at least the most of the rest of the industry. It discredits you because it makes you appear to only approve of the training that YOU obtained. I have never been trained in a creitical care setting and have no desire to be but I do happen to know that anyone giving conscious sedation not only goes through an approved training process but has proven themselves capable through experience before even being considered for training. What about the MD that is present? Nurses generally aren't doing this in a vacuum. Is he/she not worthy of your trust without being an anesthesiologist? WCI have always been, and always will be, even from the sidelines, a WCpatient advocate.  Every nurse should be, and no nurse should do a WCprocedure she or he has not be trained or licensed in.  Because it is WCdone, to save money for the bean counters, does not make it right.  Any WCnurse who does this is a fool.  That's the way I see it. WCWill, crna /**********************************************************/ /* Brian                                                  */ /* This e-mail address is being protected from spam bots, you need JavaScript enabled to view it                                         */ /*                                                        */ /* Sent from Scab.Org                                     */ /**********************************************************/ This message generated from Scab.Org

I agree 100% there. What discredits your point, at least in my mind, is the force with which you discredit a training program approved by at least the most of the rest of the industry. It discredits you because it makes you appear to only approve of the training that YOU obtained. I have never been trained in a critical care setting and have no desire to be but I do happen to know that anyone giving conscious sedation not only goes through an approved training process but has proven themselves capable through experience before even being considered for training. What about the MD that is present? Nurses generally aren't doing this in a vacuum. Is he/she not worthy of your trust without being an anesthesiologist? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The training process by whom?  You do not seem to realize the very thin line between consciousness and anesthesia.  It is very very thin. If the patient goes beyond consciousness, he is then anesthetized, by an untrained, unlicensed person.  The doctor who is present would NOT be trusted by me unless he or she was trained in resuscitation, and the treatment of anesthetic overdose.  That does not mean I don't respect the physician or anyone else there, it simply means they do not have the knowledge to do what they do, in many cases.  How many physicians other than an ER doctor or anesthesiologist do you know that can intubate a patient in seconds?  Very few, if any.  An ENT can do it, but not quickly.  Most of them could maintain an airway.  You are giving the MD carte blanche just because of their medical background.  That does not make them proficient in anesthesia.  We could argue all day Brian, all day.  I would not change.  I would refer you to the archives of GASNET, the international forum for people in anesthesiology.  Most of them are doctors, many are CRNAs.  Read what they have to say about conscious sedation and the dangers thereof.  It isn't a case of my territory either, it's a case of mortal danger to our patients. Most folks in anesthesia have too much work as it is.  There is a national shortage.  That is what this is all about.  Patient care, and giving anesthesia to any patient by a person who is not trained or licensed, is not decent care.  The training you speak of is inadequate, and not up to life saving quality.  Too many people have lost their lives during this innocent procedure. Will, crna

 When things go bad during anesthesia, they can go VERY bad very quickly. << Exactly.  Thank you for saying it better than I did or could have. It *is* anesthesia, no matter what they call it, conscious sedation used to me MAC Monitored Anesthesia Care.  (Not minimal alveolor concentration as studied and written about by EGER, UCSF).  Insurance companies would no longer pay for it, anesthesia professionals, be they doctors or nurses, would not work for free.  Enter RN (untrained but confident in his/her ability to push a plunger as ordered by The Doctor.)  They had a smattering of how to administer Fentanyl, midazolam, propofol, et al . . . usually taught by a hospital pharmacist who hadn't a clue how to really administer anesthesia.  They know HOW to dispense it, and sometimes, the dose. But what IS the dose of Fentanyl? Ask the Russians how to administer it to a theater full of patients. Anyway, Conscious Sedation can be Lethal.  Before you give it to me Sister or Brother, I want to see your damned credentials.  Count on that. Will, crna

my question is since when have they started using propofol for conscious sedation? the only thing that I can think of that we use is  midaz, diazepam, fentanyl, and  ketamine the only time I've seen it used was for induction then intubation is it commonly used for conscious sedation? just a question. jenn

   * Propofol has no known reversal drugs. “Unlike midazolam, Demerol, Valium and morphine, where you could give Romazicon and Narcan to reverse, if the patient is given propofol and develops apnea or hypotension, it must be treated by means such as mechanical ventilation and advanced airway support until the drug is _meta_bolized,” says Donald Weninger, MD, an anesthesiologist and the medical director of the Medical Group Surgery Center. Actually, the half life of propofol is short enough that a simply bagging the patient for a few minutes should be adequate in providing support in the case of apnea.  For pressure problems, just slap a 10lb. Buck's traction on the Foley. That said, propofol is a poor choice for CS.  An M&M coctail (morphine and midazolam) does an excellent job for CS, and is reversable.  We typically only use propofol as a gtt on patients who will be intubated for more than a few hours as continual sedation. Be well... Robert