Diplomate, Board Certification of Emergency Medicine
There are possibilities for making painful procedures go
easier, and these should be available in all emergency
departments. One that is easily administered is nitrous oxide
or laughing gas. It is a amnesic, meaning the patient may not
remember what occurred during the time he received the gas,
and it is analgesic, meaning it controls pain. However, its
effects are not that strong and it often causes vomiting if
used for more than a few minutes.
This is a good place to say that stuffing your child with
Bamba while waiting to do a painful procedure is never a good
idea.
Ketamine is another old drug that is great. The patient is
out and will remember nothing. The eyes remain open and the
breathing is not affected. However, recovery time can be
prolonged.
Tranquilizers such as valium work well and can be given by
mouth, by the rectum or by injection. They can affect
breathing and do nothing for pain relief. Pain relief must be
given.
I love a medication called propofol and a related cousin
called etomidate. These medications do the same as
tranquilizers, but they give much deeper sedation more
reliably. The best part of this is that the drug wears off
very fast and pain relief is generally not needed as the
sedation is deep. Propofol does affect breathing, and
etomidate does not, but etomidate is much more expensive.
Chloral Hydrate is sometimes given by mouth or rectally to
sedate kids to do a CT scan. I do not like this side-effect-
ridden drug that can not be controlled well.
In the emergency department, fasting helps but usually does
not affect our decision to use sedation. I do not expect you
to remember all the agents, but take this article with you
when you go to the hospital. It is your right to insist on
pain relief and not have your child pounced on by large
humans or tied down. You should also be present for the
procedure and do your best to be supportive and helpful.
Let me also add that these agents are not general anesthesia.
The agents used before an operation cause much deeper
sedation, and need a respirator to control breathing. They
must be given on an empty stomach. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. Flolan is the only approved treatment for
pulmonary hypertension, a devastating disease that often
results in the need for heart and lung transplant. No other
drug can be as effective in helping -- another sign of
Glaxo's commitment to your health.
