For blood pressure control, doctors resorted to showing gory movie scenes and pictures of Roseanne Barr, hoping to induce vagal reactions. The old technique of using rotating tourniquets was revived for the treatment of pulmonary edema. One patient remarked that the limb numbness was pretty bad but it made him forget about his dyspnea.

Replacing lidocaine was more problematic. Some physicians tried injecting plain saline. This worked briefly, but for longer procedures it proved no better than hand holding. Doctors at many hospitals resorted to whacking a thumb with the PDR to distract patients from the pain of suturing. Saying, “Come on, be a man,” over and over again seemed to have a positive effect as well.

At many hospitals, propofol was already in short supply and ketamine was forbidden in the ED. The loss of etomidate caused emergency physicians to be creative in their efforts at procedural sedation. Some tried showing a tape of the latest State of the Union address. Sleep came quickly; however, it was short-lived and was followed by crushing depression. One patient was nearly killed when he ran into traffic screaming, gown flapping in the breeze, and waving the New Hampshire state flag. Eventually chloroform became the new standard for sedation but not without a learning curve. Several residents required brief ventilation by bag valve mask. One commented that it was his best sleep since the lecture on psychiatric emergencies.

That’s my story and I’m sticking to it.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.