Primary Survey
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It is increasingly common for sedation to be given in the emergency department, and in recent years emergency department physicians have started to use a much greater range of drugs than the slug of 10 mg midazolam that I remember from my early days in the speciality (well they were sedated!). We never considered awareness back then, but it clearly is an important issue for many patients who undergo a painful procedure. Swann et al have specifically looked at the incidence of awareness in patients undergoing emergency department sedation and found a relatively low rate of 7.4% immediate recall and 4.5% delayed recall of events. Many patients remember dreaming, though the nature of the dream is sadly not reported. Overall a high level of satisfaction was reported, which again strengthens the argument for procedural sedation in the emergency department.
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One of the more challenging aspects of being
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