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The Pit!

20/06/10

Welcome to “The Pit” (thanks Dr. Hines!).  This is our forum where you can post comments, ask questions, and in general mouth off about what’s going on.  Most importantly it’s where you, the Military Emergency Physician, can ask questions or get feedback about any topic of of interest to our community.  The rules are simple and obvious….keep it relevant, and keep it professional!

 

OK folks, sound off!

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6 Comments »

  1. Let’s get this going…who’s going to ACEP in Las Vegas? I’ll be there Tuesday-Friday

    Comment by Todd Parker — June 20, 2010 @ 11:55 AM

  2. Thanks for setting this blog up Todd, I think it has a lot of potential!

    1. Anybody know the status of the Mobile Trauma Bay (MTB)? A corpsman just back from Afghanistan told me “they” are getting rid of it. Who decides?

    2. Anybody working on ED supplies?

    3. What’s everybody’s deployment rate? Here at Pendelton it seems to be about every 1.5 to 2 years for a healthy male.

    4. Anybody know what’s going on with the MEU billets? We’re a little in the dark here at Pendelton, though I’m not necessarily the one to ask. We’re supposed to get a bunch (4?, 6?), but it’s not clear if they are going to work for us; since the Marines own them, I guess they have to get the Marine CO to let them work at our department. That leaves us real short in July/August. At least we feel short, I’m not sure how we compare to other places.

    5. Why is Craig Schranz so hairy? (Is that unprofessional?)

    Comment by Rich Childers — June 21, 2010 @ 3:42 PM

  3. What are people using for procedural sedation? At pendleton we use ketamine or fent/versed. Not allowed propofol, for now.

    Comment by Rich Childers — June 30, 2010 @ 6:12 PM

  4. Rich, it depends. We use ketamine for most pediatric sedations, and ketamine with low dose benzos, ketofol, or propofol for adults. I’d encourage you to work to get propofol, several good studies have shown that it not only has the highest procedural success rate, but is the most cost effective also. Ketamine is fine for adults too, and you can give a low dose benzo to blunt emergence. A single dose of zofran is nice too to prevent post sedation emesis. Fentanyl/versed has the highest complication rate, lowest procedural success rate, and is also the least cost effective option for sedation of all these choices.

    Comment by Todd Parker — July 1, 2010 @ 9:25 PM

  5. Thanks for the sedation info Todd. We are updating our policies to correspond with BUMED which allows for propofol. One problem though, a single provider can’t push propofol and do the procedure, so we can’t use it during single coverage times. Bummer. I know this is also a national issue, CMS, etc.

    By the way, the MEU folks at Pendleton are doing close to 1 FTE.

    Comment by Rich Childers — October 6, 2010 @ 5:50 PM

  6. Hi Rich. I think propofol is an excellent choice especially since it can be easily titrated via pump – This seemed to be the sedation agent of choice when I was working in Anesthesia. I believe you will need to have at least a sedation trained nurse assist you but at least it wears off quickly and without the special K loopiness. BTW I second the question about Schranz.

    Comment by TRUONG NGUYEN — October 9, 2010 @ 8:47 PM

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