The patient required procedural sedation for ___

Pre-Sedation
_X_ Procedure and sedation options, risks, and benefits explained
_X_ Pre-sedation assessment performed
Full written and verbal consent were obtained prior to sedation. Generally speaking, procedures and procedural sedation performed in the ED are undertaken in an emergent fashion. Although NPO status is always a consideration, the emergent nature of the procedure takes precedent. All risks benefits and alternatives were explained and accepted.
Suction and advanced airway equipment were at the bedside in the event that these tools were necessary. The patient was placed on a cardiac monitor, continuous pulse oximeter and supplemental oxygen prior to the onset of procedural sedation.
Pre-procedure evaluation for overall anesthetic risk was performed.
A time out was undertaken to determine that this was the correct patient and the correct procedure for this patient.

Sedation
Medications were delivered to the patient to achieve the desired effect of adequate procedural sedation.
Medications:
Total time ___ greater than 15 minutes

Post Sedation
The patient was observed for quite some time with no evidence of significant desaturation or dysrhythmia. The patient tolerated procedure well and there were no complication. After recovering from sedation, the patient is alert and oriented with stable vital signs.

PEARLS

• Sedation Meds
  • Propofol
    • 1 mg/kg bolus then 0.5 mg/kg PRN
    • Burns on injection, can precede with 20mg lidocaine to numb vessels
    • Ann Emerg Med 2008;52:392-398
  • Ketamine
    • 1.5 mg/kg bolus then  0.5 mg/kg IV PRN
  • Elderly
    • prefer propofol
    • consider half dose
    • avoid benzos
  • Cardioversion
    • Fent + Etoidate
    • Midazolam
• ASA Sedation Scoring
  _ Class I – A normal healthy patient
  _ Class II – A patient with mild systemic disease
  _ Class III – A patient with severe systemic disease
  _ Class IV – A patient with severe systemic disease that is a constant threat to life
  _ Class V – A moribund patient who is not expected to survive without the procedure
• Mallampati Airway Assessment Scale [2]
  _ Class I – Airway has all structures visible
  _ Class II – Airway has uvula masked by the tongue
  _ Class III – Airway has hard and soft palate visible
  _ Class IV – Airway has only hard palate visible