One of the favorite sayings of someone I worked with decades ago was “What’s sauce for the goose is sauce for the gander”, by which she meant either “what goes around comes around”, or “If it’s good enough for you, it’s good enough for me.”
During our formative EMS years a good EMS program will try to work some of that philosophy into the training. We’ve all been backboarded and learned first-hand the importance of void space padding, for instance. Some courses allow us to partner up and practice IV sticks together, which is another good first-hand experience. Better EVOC programs will allow the driver-on-deck to ride strapped to the cot, to feel exactly what a pothole or speed bump is like for the patient.
But there are certain things we just can’t do, like try out the drugs in the drug box. We don’t for instance stare in horror at the spreading stain on our crotch and say, “Oh, yeah, I get it – Lasix sure does work!”
It happened Monday though that I had an appointment with a full-sedation dentist. The tooth which needed a crown refused to go numb no matter how much novocaine my regular doc pumped into it, and this is what happened. I’m skipping over the initial meet & greet and exam from last week.
I was given a 25mg tab of Meclizine, two 500mg tabs of Acetaminophen, and 0.3mg of Clonidine to take 90 minutes prior to the appointment. I was told that the Clonidine might make me woozy, so I had She Who Must Be Obeyed drive me to and from the procedure. Additionally, I applied some Burt’s Bees lip balm to make my lips happier about being open for long periods. I also used a Vicks inhaler in each nostril to chill out the nasal passages, knowing I was getting a nasal intubation.
At the dentist’s office I felt not the slightest bit woozy despite their warnings. Okay, no biggy.
I was called back to the room – a regular dental exam chair, a bit more equipment. Expecting a chilly OR I had worn a sweater, but removed it and hung it behind the door at their request.
A young lady introduced herself as a doc at the practice, though not the doc who would be doing the dentistry. She put a #20 in my right hand and start a WO drip of lactated Ringer’s. They knew your humble narrator is a paramedic and were very understanding and patient with all my questions.
Another tech placed a standard 3-lead EKG. She then placed a short headband over my forehead which connected to an EEG. This, I had been told, was to ensure that the anesthesiologist knew I was really “out”. We’ve all heard the stories of the patient who was “sedated” and paralyzed, but could hear, think, and – shudder – FEEL everything going on, yet unable to alert the OR staff. None of that for DTs!
All this had taken perhaps five minutes. I turned to ask the doc who had started my IV what the initial drug given would be.
“Oh, Versed,” she said. Oh, good, I thought.
I was standing in the doorway of their bathroom, facing out towards the hall. I noticed I had my sweater on. I could feel the dental work with my tongue. My left sinus felt strange and I asked what gauge they’d used (#8). One of the techs asked if I needed to use the bathroom. I said “I guess not.”
I was in the car.
I was in bed, and slept for six hours.
I woke to use the bathroom and noticed my lower lip was tingling in that “coming down from novocaine” feeling.
Slept for two more hours.
Woke up, more or less intact. Tooth pain 0/10, gum pain 0/10, jaw pain 0/10, lip pain 0/10, left nasal passage 1/10 and a slightly sore throat and somewhat raspy voice.
“So,” said She Who Must Be Obeyed. “Are you going back like you said you would?”
“I what now?”
“After your procedure, you had so many questions – which they considered good questions indeed – and showed such professional interest, they invited you back to watch one whenever you liked.”
“Really?” Oh shit oh dear, DTs, you have no recollection of that at all. How much did you run your mouth, just out of anesthesia?
So there, for we who give it, was my first-hand experience of midazolam.
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