You ever want to sedate someone for an EMG?

[PMR 4 MSK]

64 yo female in today for EMG LLE. I go to mark the EDB and AH, and when I touch her with the sharpie marker, she jumps and gasps - "Sorry, I'm just nervous." A minute later I touch her with the stimulator and she almost jumps off the table - and I didn't even do a stim yet.

At 50 mA stim over the peroneal and no response yet she says "are we done yet?" No.

When I stim below the fibular head "Is that it?" No. I'll let you know when we are done.

The H-reflex was a lot of fun, especially when I got up around 50 mA at 500 mcS.

When I do the needle exam, she jumps again when my gloved hand touches her. I tell her I need her to hold still so I can insert the needle. After I've already stuck her and am exploring the muscle she says "When are you going to stick me?"

When I needled the FDIP, despite holding her foot down, she jumped so hard the needle came out and I had to stick her again.

I've never sedated someone for an EMG, but boy, did I want to today...

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[SSdoc33]

uggh. just reading that post frustrates me, b/c i can totally sympathize with you. i find myself having less and less patience for these types of patients. its just like "c'mon, get over yourself", its not THAT bad.

as far as the sedation goes, i think thats a bit overkill and it'd be hard to tell which ones really need it prior to the procedure. maybe some oral valium for the ones who you have a good idea will be a baby about it.

on the other hand, i try to avoid spinal injections on these patients because if they have that muchtrouble with an EMG, you are begging for a problem with a LESI......

 

[PMR 4 MSK]

It's also fun with really anxious patients to get them to follow directions for the needle exam - "Push your elbow against me. No your elbow. No, the other elbow, the one I'm pushing against. No, push against me, don't pull it into you. Ok, good, ok, thats enough. Ok, you can let your arm relax now. You can let it down. Go ahead and relax your arm, let it fall down to your side. No, don't push against me again until I ask you..."

 

[topwise]

I've had some crazy extremes:

I had one patient who we gave pain med to before the exam, but she was screaming at the top of her lungs and cursing with tears rolling down her cheeks. Every time we asked her if she wanted us to stop, she said she wanted to keep going.

I had someone faint on me last week.

And I had someone fall asleep.

 

[Ludicolo]

I ‘ll use conscious sedation occasionally, but only for peds patients.

I’ve had patients take a swing at me.

I’ve performed the exam on patients/prisoners in restraints, with the corrections officer standing at bedside.

There was one instance where, as a resident, I had both the patient and the observing attending fall asleep during the exam.

And I’ve had some patients actually request that I check more muscles with the needle.