Procedural Sedation Errors

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

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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.