Procedural Sedation Part 1- Preparation

EM Basic

EM Basic LLC

Residency, Student, Medicine, Er, Em, Intern, Health & Fitness, Medical, Education, Emergency

4.6 • 665 Ratings

🗓️ 1 July 2012

⏱️ 24 minutes

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Summary

This is the first of two episodes on procedural sedation. In the ED we need to provide safe and effective procedural sedation and analgesia whenever we do painful procedures. It is our job to relieve anxiety and pain in our patients and we need to know how to do this right. This episode will focus on how to prepare for a procedural sedation. We will talk about how to make the decision as to who is an appropriate candidate for procedural sedation in the ED, the depth of sedation, and how to prepare all of our equipment so that we leave nothing to chance. This will be in preparation for the second episode where we will talk about the medications that we use in procedural sedation.

Transcript

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0:00.0	This is Steve Carroll and you're listening to the EM Basic podcast. Today is part one of a two-part
0:06.3	series on procedural sedation and analgesia. The old term for this is conscious sedation,
0:12.6	but the term procedural sedation is a much better description of what we do. In the ED, we have to do
0:18.5	procedures that will cause patients to have anxiety and pain, and it's our job to take that away.
0:23.9	Long gone are the days of putting in chest tubes and setting fractures with no analgesia or sedation.
0:30.9	We owe it to our patients to not cause them unnecessary pain and suffering, and procedural sedation and analgesia is the way to do it. Just as important,
0:39.8	we also owe it to our patients to do procedural sedation in a safe manner that won't cause them any
0:44.9	harm. You can get into some serious trouble if you don't do this right, so our utmost focus
0:50.6	during these two episodes will be patient safety. In this first episode, we'll talk about the preparation and decision-making that comes into
0:58.8	doing a procedural sedation.
1:00.7	In the second episode, we will talk about the actual medications that we use in procedural
1:05.1	sedation.
1:06.1	The reason why I am breaking this up into two episodes is that the preparation and decision-making is the key to making procedural sedation safe and effective.
1:15.2	So I wanted to take an entire episode to focus on this aspect before we talk about which medications to use.
1:22.1	That way, you can take some time to mentally digest the preparation and its decision-making part before we talk
1:28.2	about medications and you forget all about the preparation part. As always, this podcast doesn't
1:33.7	represent the views or opinions of the Department of Defense, the U.S. Army, or the Shawshack
1:37.1	Emergency Medicine Residency. So let's get started. The first thing you need to do in preparing
1:42.4	for a procedural sedation is to do a history
1:45.4	and physical, paying special attention to comorbidities and MPO status.
1:50.4	You need to do a history on the patient to find out what medical problems that they have.
1:55.6	Ask them if they snore a lot at night, which can be suggestive for obstructive sleep apnea.
	...

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