PSA
Procedural Sedation Errors
Error #1: Delaying deep sedation until fasting times are met
Error #2: Believing PSA carries less risk than endotracheal intubation
Error #3: Minimizing risk of airway and breathing complications while using ketamine
Error #4: Not having full intubation setup nearby
Error #5: Responding to hypoventilation or apnea with early and/or aggressive use of the bag-valve mask (BVM)
Error #6: If the oxygen saturation is ok, then the patient is breathing ok
Error #7: Withholding ketamine sedation on adults
Error #8: Adding an opioid with ketamine for sedation
Error #9: Using the same dosing strategy for propofol sedations as with fentanyl/midazolam
Error #10: Using the same PSA dosing strategy for the elderly
Prostate Cancer Screening Test (PSA)…A Waste of Time!
- No level of Prostate Specific Antigen (PSA) completely excludes prostate cancer.
- The prevalence of undiagnosed prostate cancer at autopsy is high and increases with age (> 40% among men aged 40-49 yr to > 70% among men aged 70-79 yr)
- Only a small proportion of men with prostate cancer have symptoms or die from the disease; most prostate cancers are slowly progressive and NOT LIFE THREATENING.
- Screening with the PSA test may lead to a small reduction in prostate cancer death but NOT a reduction in all-cause death rate.
The PSA test should NOT be used for screening without a detailed discussion with the patient, ideally with the use of decision aids to facilitate comprehension.
When you have to put the child to sleep for a painful procedure
When dosing oral midazolam for anxiolysis – like when you’re doing a procedure – you can dose above the listed limit of 0.5 mg/kg. In fact, you can dose up to 1 mg/kg!
For the child who is preschool and under I will typically give the following dose: 0.7 to 0.8 mg/kg
DO NOT FORGET THE PAIN KILLER!
Recommendations on screening for prostate cancer with the prostate-specifi antigen test
• The prevalence of undiagnosed prostate cancer at autopsy is high and increases with age (> 40% among men aged 40-49 yr to > 70% among men aged 70-79 yr)
• Only a small proportion of men with prostate cancer have symptoms or die from the disease; most prostate cancers are slowly progressive and not life threatening.
• Screening with the PSA test may lead to a small reduction in prostate cancer mortality but not a reduction in all-cause mortality.
• Thresholds for PSA of 2.5 to 4.0 ng/mL are commonly used for screening; lower thresholds increase the probability of false-positive results, and no threshold completely excludes prostate cancer.
• Harms associated with PSA screening (e.g., bleeding, infection, urinary incontinence, a false-positive result and overdiagnosis) are common.
• The PSA test should not be used for screening without a detailed discussion with the patient, ideally with the use of decision aids to facilitate comprehension.
