A member of DOCS Education asks:
I have a patient interested in sedation but I have several concerns with her health. The patient has lupus, sarcoidoisis and rheumatoid arthritis. My practice is located in VA and, therefore, I am only able to use single dose protocols. With the fact that she takes Azathrioprine, Ventolin® and Hydroxycholorquine for her systemic issues, would you recommend IV sedation instead of oral? Patient is coming in tomorrow for a consultation and I have been waiting to get the medical consults back. Her primary care physician took no issue with the use of normal protocols, but I am not comfortable doing that. I have yet to hear from her pulmonary physician or the rheumatoid doctor. What would your advice be for this case? Thank you.
Dr. Jerome Wellbrock, DOCS Education faculty, responds:
The most important thing you have said is "I am not comfortable with that". Put her sedation on hold until you have heard from her pulmonary care physician. If you are still uncomfortable with anything about this patient after speaking with her doctors, the best thing you can do for the patient and for yourself is to refer to someone else who is trained and equipped to manage her in the safest way possible.
Dr. Lesley Fang, Medical Director of DOCS Education Faculty, adds:
This is an ASA 3/4 patient, depending on the extent of her disease involvement. This patient is not an ideal candidate for single dose, single drug sedation for several reasons:
Lupus: While hydroxychloroquine is usually for skin and joint disease, we need to know about any Hematological involvement. Is there anemia, leucopenia or thrombocytopenia? And is there any renal, pulmonary or cardiac involvement?
Sarcoidosis is often associated with interstitial lung disease, which is the most likely reason for her Azothiaprine use. You would need to know, also if there is hypercalcemia, cardiac or renal involvement.
Rheumatoid arthritis is primarily joint disease, but you need to be aware of any lung involvement.
As indicated, more information would be helpful, but you are right to be uncomfortable.
