This evening I took care of a young man with a shoulder dislocation. It has happened to him so many times he doesn’t know the actual number. That’s not the unusual part.
As I was preparing him for the relocation procedure (I use etomidate, a drug from the gods of medicine), I was explaining what I was going to do,
RBA, etc., and there was a brief slack period. That’s when I looked up at the TV (a few of our rooms have TVs in them, mounted well up the walls).
It was The Quiet Man, and I said (without prompting, and with pretty much a captive audience): "That movie must be pretty cheap. I’ve seen it about 5 times in the last two months. One of John Wayne’s least known films, and perhaps some of his best acting". Given the silence, I was aware that my comment was odd, so I told him the Movie Review was on the house.
The patient was enjoying the movie as he drifted off to sleep. His relocation was more smooth than the dialog, though he’ll never know it.
Oddly enough, speaking as a patient, this is the kind of dailog people like when they have to go to the hospital.. something that takes their mind off what is going on. Good bedside manner, doc.
Am I wrong to be disturbed that drug-from-the-gods etomidate is specifically indicated for “Rectal foreign body”?
No more disturbed than I am that the one indication you really noticed was, well, that one.
People who get sedated for such proceedures are so lucky! (ok, so I’m the rare bird that they try to avoid the sedation in, but that is beside the point!)
My shoulder relocations are done with locals and pain killers. :(, not fun.
Then again, my EGD today was done without sedation too.
Curious. Did he just have hypermobility, over rambuctions/risk taker or did he have Elhers-danlos syndrome?
I like etomidate, but have been using propofol for most of my conscious sedations for about the last year. Is there any reason to use etomidate instead of other sedatives? I do use etomidate for a majority of my RSI Intubations.
Darren,
I use it because it’s cheap, we use it a lot for RSI so the nurses are comfortable with it, and we don’t keep propofol in the ED.
Also, I like the near-perfect reliability of dosing to get the effect I want; none of thet ‘give a little more’ to get the sedation required.
Propofol would be better for a longer procedure, where re-dosing might be an issue.
IMHO, YMMV, etc.
hey, what’s with the cryptic alphabet soup
The only soup in there has little dots under it. One this blog, that means that if you hover your cusor over it an explanation magically appears!