Hello, med students. My name is Zach Olson, and thank you for downloading this episode of the EM

Clerkship Podcast. Today, we are talking about one of the core medical procedures in emergency medicine.

Procedural sedation. This is the procedure that we do with every other procedure. This is how we reduce fractures, cardiovert hearts, even things like

popping, abscesses and doing lumbar punctures without the patient losing their minds and freaking out.

And so what we are going to do today is first cover a super quick three-step approach to procedural sedation.

And then we are going to go through the five medicines that you will see attendings use for procedural sedation during your clerkship.

We've got lots to cover today, so let's get moving.

Here's a quick three-step approach.

Step one, you need to channel your inner anesthesiologist and record their two favorite scores. the Malampati score and the ASA.

First, determine a Malampati Airway score.

From easy to hard, just like in video games.

Level one is you can see the whole uvula just

dangling there. Level two, you can still see most of it. Level three, now you can barely

see it. Level four, not even visible. Very hard airway. You also need to determine the

ASA score, which is basically how healthy they are.

Again, just like in video games, there's easy to hard.

Level one is really healthy.

Two is some mild illness like high blood pressure.

ASA 3 is a lot of illnesses.

So diabetes, COPD, heart disease, ASA 4 is sick and dying,

in stage renal disease, advanced cancer, that kind of thing.

And ASA 5 is basically dead.

...