The Days Before Propofol

Ah, memories of residency.

I did my residency at a major trauma center in the inner-city. As you can imagine, my days and nights were filled with drunks that were beaten up and thrown out of bars. Usually people like this don’t want to sit still for the necessary studies they need. These days we can use a Propofol drip to keep them calm. Back then I did not have this option. In fact, back then I had to mix up the vast majority of drug infusions myself! EES was the only Macrolide we had!
It was a combination of “brutaine” (strong people holding them down), 4 point leathers, and massive doses of Haldol and Ativan. It was not uncommon for people like this to spend five or six hours in the department. Usually I had to spend the vast majority of my time with one patient like this just to prevent them from ripping their ET tube out or demolishing the entire department. Most of this was spent trying to keep them still on the table to get x-rays and CAT scans.
One time I got signout on someone like this that during the previous residence shift he had to give 20 mg of Ativan and 30 mg of Haldol IV over about four hours. This particular guy was not intubated yet. Generally that was the only solution to keeping someone like this still. Intubation and parallelization.
Nowadays unless they’re hypotensive, you just put them on a Propofol drip and be done with it. If I had this option during residency, I could’ve seen three times the number of patients per hour.

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