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Kevin
I am happy to offer advice.   Welcome to hospital politics and the some realities we face in peds em. 

I am a peds ed doc and founded one of the early sedation services with propofol etc in 2004 and helped found the SPS.   Your task now is much easier as the Society for Pediatric Sedation and others have published much data.  

The challenge you face is political and also due to the limited and variable training in sedation in peds em.   Most peds em have little training related to deep sedation  Variation in training and practice leads to lack of trust. 

I have given propofol likely 15k times.  Now doing locums in some er’s I can use it and others I can’t.  Sedation practice remains highly variable.  Monitoring remains weak and the crazy and useless sedation tests remain for credentialing.  The tests aren’t even standard. 

It’s time for peds em to embrace better training and recognize the risks of deep sedation.   If you want to solve politics, partner with anesthesia.   Help them recognize your respect for deep sedation, close monitoring and the incredible patient benefit of adequate sedation including deep sedation with any medication.  Engage in qi.  

The deepest sedation I have seen is with chloral hydrate.  Cote’s Early article on claims around sedation point to lack of training and monitoring.  It’s not the drugs or the route.  

You can make a great argument but base it on improving training, monitoring and qi.  Work to reduce variation in your group.  

SPS has a sedation course and conference in Atlanta coming up.  Might be worth checking out. Great multidisciplinary group and leading the way.  

Mick Connors MD 



> On Apr 26, 2018, at 12:01 AM, PED-EM-L automatic digest system <[log in to unmask]> wrote:
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> There is 1 message totaling 53 lines in this issue.
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> Topics of the day:
> 
>  1. Propofol in Peds ED
> 
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> ----------------------------------------------------------------------
> 
> Date:    Wed, 25 Apr 2018 17:56:29 +0000
> From:    "Carney, Kevin" <[log in to unmask]>
> Subject: Propofol in Peds ED
> 
> Colleagues -
> 
> Due to the ongoing shortage of a number of sedation meds we use in our ED - specifically ketamine - we are working on plans to conserve our supply and look for other options. One option we'd like to pursue is the addition of Propofol but have come across some logistical (and political) barriers in the past in our institution.  I'd love to ask if anyone who currently uses Propofol routinely in their Peds ED would be willing to 1) Just let me know, as I'm trying to build my case by showing what other similar institutions are doing and 2) share any pertinent documents about provider/staff education, competency, protocols, etc.
> 
> Thanks very much for your time, and happy sedating!
> 
> Kevin
> 
> ______________________________________________________________________________
> Kevin P. Carney, MD | Medical Director | Emergency Department - CHCO Anschutz Campus
> Assistant Professor of Pediatrics | Section of Pediatric Emergency Medicine
> University of Colorado Denver School of Medicine | Children's Hospital Colorado
> [log in to unmask]<mailto:[log in to unmask]> | Office: (303) 724-2580
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