Conscious Sedation in the ER

Well the ED I just left we used just about them all with our preference being Propofol or Etomidate, due to the fact that they were short acting and after the pt was recovered another 30 mins to an hour they were discharged. I hate Versed with a passion, those pts are rarely gone from the department within a hour or two.

Our protocol for the first two drugs did require RT or a second doctor at the bedside, as did Ketamine. Also the MD was required to push those meds, though I could give them during intubation.

I work in Peds ER. I have seen Versed and Ketamine used.

Depends on the doctor.
I prefer they use etomidate, as mentioned, the patient is G-O-N-E seconds after giving it and recover quickly afterwards. We usually use it in reducing joint displacements, as it relaxes the muscles also.
Maybe it has only been my experience with versed, but I do not like using it. It makes patients goofy and takes forever to recover.
This is the ER, remember. In, Out. Thank you.

i just did a peds cons. sed. and used ketamine. not sure i like it. lights are out but no one is home.

We generally use Ketamine + something for pain control for kids, Etomidate + something for pain control for adults. Depends on why we're doing the sedation, really, and it also depends on the doc's preference; seems like we do them most often for reducing fractures or dislocations. But we have very strict guidelines for pre-procedure documentation and consent, monitoring and assessment during and post-procedure, and it becomes a 1-to-1 nursing situation for at least 30 minutes after the procedure is complete.

I don't like giving kids Ketamine -- I've seen one kid come out of it with the screaming meemies. Ugh. Took him a few minutes to calm down, and then he had no clue why he freaked. LOL.

Although each doc has their preference we generally use etomidate, versed, fentanyl, and ketamine for peds (although i haven't done that one personally), i was just asking our pharmacist about propofol the other day because some GI staff MD came in as a pt with Afib with RVR and was demanding to have propofol and to be cardioverted although cardiology and ER MD's said no haha, pharmacy said the only times we use propofol in our ER is for neurosurg patients but i forgot what the clinical indications were that he stated.

We use quite a bit of conscious sedation in our ED, both for Paeds and Adult as well.

IM Ketamine for most paediatrics patients.

IV Propofol for most Adults (dislocations, closed reduction of fractures), but sometimes Versed and Fentanyl depending on the procedure.

We have very strict controls on the room we use (airway, monitoring), close vital signs monitoring until returned to baselin, RT at bedside, 1:1 RN at bedside until recovered.

One bit of advice. Never draw up the meds until the patient is fully monitored and you are comfortable to procede. THe MD will be pressuring to go ahead, but until you hand them the drugs they have to wait until things are set.

Probably the sketchiest conscious sedation I had ever been involved in was the elective cardioversion by a Cardiologist. He came to consult, called his Anaesthesiologist from the OR. Anaesthesia shows up with their own drugs. Pt isn't even on the monitor and he's pushing a full dose of sedation. I freak on him as RT isn't even in the department. "I don't need an RT" he says. Great !!

7 minutes later he walks out of the department, We are left recovering the patient (we're not a PACU here folks) with persistant hypotension, oral airway, and BVM. What a **** up. After that safety report anaesthesia is no longer allowed to come into the ER for elective procedures.

What a Wanker...

We have two types, moderate sedation (which is usually versed and fentanyl), and deep sedation (which we can use etomidate, ketamine, propofol-pushes only, no gtt, and brevital). We have VERY strict guidelines and monitoring requirements. They are done in our code rooms, we monitor all VS including CO2, etc. The ketamine can only be used on kids up to age 12, and I have seen the docs typically giving a small dose of versed with the ketamine to help with the hallucinations and nightmares that can sometimes come with it...I have had absolutely no problems with any of the meds (knock on wood)...I actually prefer the deep sedation drugs, because like others have said, we get the procedure done quick, and the recovery time is so much faster!

We use versed, and fentanyll or demerol sometimes propofol.

Our facilty is using etomidate ketamine and propofol for consious sedation regularly. There was some question about who can give it and now they say the nurse can administer it in the ED only before they said we could not now they say we can . The only stipulation is that there be an MD (ED attending) present who is also certified in consious sedation. I know the GI unit can use etomidate for sedation per the MA board not sure about their stance for ED or the other meds.