This is Steve Carroll, and you're listening to the EM Basic podcast. Today is part two of the

procedural sedation podcast. In this episode, we'll talk about which medications we use for procedural

sedation. Choosing the right medication for your patient's sedation, we'll keep them safe,

help them get through the procedure with a minimal amount of pain and anxiety and help them recover quickly.

We'll start off by talking about the use of oxygen during procedural sedation, followed by a review of simple airway maneuvers, and then move on to different medications that we can use for procedural sedation.

As always, this podcast doesn't represent the views or views or opinions of the Department of Defense, the U.S. Army, or the Shawshack Emergency Medicine Residency.

Let's start off by talking about the use of oxygen during procedural sedation,

because some people have different opinions about this.

To be honest, I think all of the evidence supports using oxygen during procedural sedation,

but let's talk about it anyway.

So here's the theory behind not using oxygen

during procedural sedation. When you don't use oxygen, the thinking is that you can use the

pulse ox as your guide to when the patient isn't ventilating very well. When their pulse ox drops,

then you know that the patient is not ventilating and you can do something about it. However,

if the patient is placed on oxygen,

this response is plunted because you are increasing the patient's oxygen saturation and their

pulse ox could stay normal for a long time without them breathing on their own. Here's my issue with

this. If you are waiting for the patient to desat to tell you that there is a problem, then you're

already behind the oxygen curve.

Hypoxia is bad, and we want to avoid it at all costs.

The reality is that even in a healthy patient, the pulse ox reading can lag at least 30 seconds

in the past and longer in critically ill patients.

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