sedation/analgesia for procedures (but not necessarily "procedural sedation")

[Boatswain2PA]

I think I have heard 50 different reasons why PAs can or can't use different meds for different situations....everything from "it's against the law for PAs to use propofol" to CMS regulations prohibuting PAs from using ketamine, etc.

 

So, anyone know the real scoop? Used both a lot as student (under direct supervision of course), are we not allowed to use on our own?

 

If not allowed, what do you use when you have to reset a shoulder, nose, or finger? What about a kid with big lac??

[EMEDPA]

it all depends on the rules of the individual facility.

at my regular job I can use fentanyl/versed only unsupervised.

at my rural job I can use anything unsupervised. 2 weeks ago I did an rsi intubation with etomidate/sux and then kept them down with a propofol drip.

at a prior per diem job I could do anything after consultation with the doc.

at my last job I could do anything but propofol.

[jen0508]

i think it depends on the hospital. where i work ketamine, propofol etc require a physician to administer and monitor and another provider (physician, PA) to actually do the procedure. there cant be 1 person monitoring the patient and doing the procedure at once. im not sure about versed though. obviously i try to avoid having to do that as it takes the doc away from whatever he is doing, is a ton of paperwork, and takes long to get the med from the hospital pharmacy. i usually give a nice dose of dilaudid before doing procedures on adults like large lacs, or things like bartholin abscesses. reducing a finger, can do a digital block. the other day i was able to reset a shoulder with no sedation using the scapular rotation method (where they hang their arm off the bed) pretty cool.

 

ive never had to sedate a kid with a big lac. (knock on wood) i use LET, and a papoose and try to smile at them alot and keep them calm lol. now that i think about it though, dont think ive ever done a lac on a kid/toddler that wasnt on the face . i dont think LET would work well on the extremities.

[EMEDPA]

Different places will define "moderate" and "deep" sedation differently. moderate requires 1 provider, deep requires 2 (unless emergent).

[Hemegroup]

ive never had to sedate a kid with a big lac. (knock on wood) i use LET, and a papoose and try to smile at them alot and keep them calm lol. now that i think about it though, dont think ive ever done a lac on a kid/toddler that wasnt on the face . i dont think LET would work well on the extremities.

 

i have a couple of times, it's no biggie. keep some flat soda in the fridge and the versed goes right down.

[LT_Oneal_PAC]

Agreed, depends on facility. I've even seen a place where only anesthesia trained personnel can use propofol, yet the ER docs could use ketamine/etomidate. Silly rule.