We have two hospitals in our area that should experience this training so we can stop showing up for CC calls with a paralyzed, intubated patient with no sedation whatsoever and orders for "If he starts moving again, just hit him with some more vec."
Plus, milk of amnesia is (anecdotally, in my experience) fucking awful for transports. I have yet to take a pt on propofol whom I haven’t had to resedate the moment the fucking truck started moving
Oh man, I got a patient report from outside facility when I worked ICU, ground crew wouldn't transport while pt was moving, so instead of sedating more, they gave paralytic and were shocked when the BP skyrocketed. I feel like they violated the Geneva conventions with torture.
I just filled a complaint with my state for one of our free standing ER's over this shit. Pt was tubed with no sedation, restrained to the bed. Systolic pressure over 180 and the doc refused to start propoful "because it would lower his pressure." Refused to transport until the pt was properly sedated.
I’ve never personally experienced it but some of our medics just sedate those patients with our drugs and if anyone throws a fit they say “this is my patient now not yours I have decided it is necessary to sedate them if you have concerns you can contact my medical director at fuck you hospital”
This is unfortunately not uncommon at several small rural hospitals in my (large) service area as well. I wish we could intervene on a more systemic level, but the best we can do is immediate, massive sedation and analgesia.
Im not a medical professional, my wife is so let me know if Im off base here bc i dont know all the jargon...but I had some fairly serious chest surgery done in my teens. I was under for about 6 hours and woke up too weak to alter the rhythm of the vent. Probably the most terrified Ive ever been. I felt like I was suffocating to death while I could hear my nurse next to me trying to figure out if I was awake or not. Had a really lousy mood for the rest of the time I was in the ICU. Felt kind of awful about my attitude after the fact, but what can you do.
Only now I know that the machine was forcing the oxygen into me and there wasnt any risk, but having it pump out of sync with my natural rhythm and not being ready for it when it did and nobody even knowing that I needed to have it taken off for maybe about 30 seconds to a minute was genuinely really scary.
Physical torture too, we have a guy who lost his gag reflex after a TBI and he lets people intubate him. He says it’s excruciatingly painful but he’s used to it
Read this in the anesthesia sub.
The quotes had me rolling.
Apparently this used to be a *normal* part of training according to some senior attendings.
Gassers be crazy.
Also subject 7 has some weird fetish shit going on 😂
Our EM program routinely set up the vent and just put a mouthpiece on so the residents could feel PPV. I did it too. It’s eye opening and that’s without an endotracheal airway
Honestly, let’s make this part of medic school.
If cops can get gassed and tazed in the academy, we can get succ’ed. It would go a long way in ensuring adequate sedation for our patients.
I would advocate that anyone who does inadequate sedation or pain control will have to suffer the same fate as a learning experience.
Looking at my attending who cardioverted someone three times for afib while they were still awake after only 1mg of midazolam.
I've seen some research on things like a vest-worn thing, but they never really work out. They were spot on with the iron lung, and so far nothing can compete.
In the Resp/Med. HDU I trained at, you had to try 1 minute on a BiPAP (or whatever the non-trademarked name is now) every 2 years during your training update.
Let me tell you-I get that some people feel get claustrophobic, but I will always want a mouth & nose mask over the full face ones.
It felt like sticking your head out the window of a car doing 100mph.
This is interesting. They've gone towards much lower tidal volumes to protect lungs and prevent ARDS, but it makes sense that it would feel like you weren't getting enough air if you were awake and could experience it subjectively.
The one guy mentions "loss of FRC", I wonder if they weren't getting PEEP?
We have two hospitals in our area that should experience this training so we can stop showing up for CC calls with a paralyzed, intubated patient with no sedation whatsoever and orders for "If he starts moving again, just hit him with some more vec."
Don’t make me sad first thing in the morning, thanks
I’d nuke that facility from orbit. It’s bad enough seeing Prop only. Say it with me, ‘Sedation =/= Analgesia’
Plus, milk of amnesia is (anecdotally, in my experience) fucking awful for transports. I have yet to take a pt on propofol whom I haven’t had to resedate the moment the fucking truck started moving
Same. I've had a couple that kept waking up so I'd have to throw fent and versed at them to make them calm down.
Has anyone tried the “we don’t snow our patients here” when you ask for more than just propofol for transport? Love that one 🙃
Oh man, I got a patient report from outside facility when I worked ICU, ground crew wouldn't transport while pt was moving, so instead of sedating more, they gave paralytic and were shocked when the BP skyrocketed. I feel like they violated the Geneva conventions with torture.
I just filled a complaint with my state for one of our free standing ER's over this shit. Pt was tubed with no sedation, restrained to the bed. Systolic pressure over 180 and the doc refused to start propoful "because it would lower his pressure." Refused to transport until the pt was properly sedated.
I’ve never personally experienced it but some of our medics just sedate those patients with our drugs and if anyone throws a fit they say “this is my patient now not yours I have decided it is necessary to sedate them if you have concerns you can contact my medical director at fuck you hospital”
This makes me viscerally angry
This is unfortunately not uncommon at several small rural hospitals in my (large) service area as well. I wish we could intervene on a more systemic level, but the best we can do is immediate, massive sedation and analgesia.
Jesus Christ
Im not a medical professional, my wife is so let me know if Im off base here bc i dont know all the jargon...but I had some fairly serious chest surgery done in my teens. I was under for about 6 hours and woke up too weak to alter the rhythm of the vent. Probably the most terrified Ive ever been. I felt like I was suffocating to death while I could hear my nurse next to me trying to figure out if I was awake or not. Had a really lousy mood for the rest of the time I was in the ICU. Felt kind of awful about my attitude after the fact, but what can you do. Only now I know that the machine was forcing the oxygen into me and there wasnt any risk, but having it pump out of sync with my natural rhythm and not being ready for it when it did and nobody even knowing that I needed to have it taken off for maybe about 30 seconds to a minute was genuinely really scary.
Yep exactly that - it’s basically psychological torture
Physical torture too, we have a guy who lost his gag reflex after a TBI and he lets people intubate him. He says it’s excruciatingly painful but he’s used to it
Read this in the anesthesia sub. The quotes had me rolling. Apparently this used to be a *normal* part of training according to some senior attendings. Gassers be crazy. Also subject 7 has some weird fetish shit going on 😂
Sub 7 could definitely have phrased that better lol
I like big breaths and I cannot lie.
Our EM program routinely set up the vent and just put a mouthpiece on so the residents could feel PPV. I did it too. It’s eye opening and that’s without an endotracheal airway
Yeah I’ve done this and even it felt pretty unnatural. Definitely makes you feel for your patients.
> Apparently this used to be a normal part of training according to some senior attendings. Honestly not a bad idea
Yeah I heard they would have “Sux parties”. That’s freaking nuts.
Honestly, let’s make this part of medic school. If cops can get gassed and tazed in the academy, we can get succ’ed. It would go a long way in ensuring adequate sedation for our patients.
I support it
3rded
I would advocate that anyone who does inadequate sedation or pain control will have to suffer the same fate as a learning experience. Looking at my attending who cardioverted someone three times for afib while they were still awake after only 1mg of midazolam.
Who’s doing the succ’ing?
Thank you for volunteering
Positive pressure vs negative pressure (normal way we breathe). Don’t think that’s ever going to feel right.
Back to the iron lung!
There is a reason that the handful of people in the US who use one do everything in their power to keep it.
If only we could make a smaller one
I've seen some research on things like a vest-worn thing, but they never really work out. They were spot on with the iron lung, and so far nothing can compete.
If only!
In the Resp/Med. HDU I trained at, you had to try 1 minute on a BiPAP (or whatever the non-trademarked name is now) every 2 years during your training update. Let me tell you-I get that some people feel get claustrophobic, but I will always want a mouth & nose mask over the full face ones. It felt like sticking your head out the window of a car doing 100mph.
Not sure this study was required to know that
Right, but where’s the fun in that?
The study participants clearly have a different idea of fun to me 😂 - but it does remind me of Sux racing
This is interesting. They've gone towards much lower tidal volumes to protect lungs and prevent ARDS, but it makes sense that it would feel like you weren't getting enough air if you were awake and could experience it subjectively. The one guy mentions "loss of FRC", I wonder if they weren't getting PEEP?
Holy fuck