Conscious Sedation in the ER

They usually use versed with another agent maybe MSO4 or something short acting. The ER docs or whoever is doing the procedure usually orders the meds. We dont have anesthesia there.(If they need an ologist they shouldn't be done in the ER) Along with the consent forms, protocols for CS etc,etc.

I WORK IN A FAIRLY BUSY EMERGENCY DEPT 43.000 PER YEAR. WE USE CONSCIOUS SEDATION WITH STRICT GUIDELINES INCLUDING DOCUMENTATION EVERY 5 MINUTES OF VS, MEDS, CARDIAC RATE AND RHYTHM, SAO2 AND LOC ACCORDING TO THE RAMSEY SCALE. WE HAVE DISCHARGE CRITERIA BASED ON THE ALDRETE SCALE, PAIN AND NAUSEA CONTROL AND STABLE VS INCLUDING SAO2. WE USE COMBINATIONS OF NARCOTICS AND VERSED AND/OR SUBLIMAZE. ON ANOTHER NOTE WE KEEP A RAPID SEQUENCE INTUBATION KIT IN WHICH WE STOCK ETOMIDATE, VERSED, SUCCINYLCHOLINE AS WELL AS OTHER DRUGS.WE DO NOT USE ETOMIDATE FOR CONSCIOUS SEDATION. WE USED TO HAVE A KETAMINE POLICY BUT WE FOUND IT WAS TOO UNPREDICTABLE. WE HAD PEDIATRIC PATIENTS WHO HAD POST-PROCEDURE STAYS OF 4 HOURS PLUS (IN THE ED) AFTER KETAMINE ADMINISTRATION. SOME OF THE OTHER ROUTES WE HAVE TRIED WITH PED PATIENTS HAVE INCLUDED INTRANASAL VERSED WITH VERY LIMITED SUCCESS.

To reply to your post. I ahve used etomadate for inutbation. I have used ketamine to sedate children, I am not a fan of it.
versed seems to be drug of choice for conscoius sedation. Remember ... don't risk your liscence if your not comfortable with any procedure. take care

I have worked in the er in my county hospital.we use versed,fentayal,etomidate.the only time i have used ketamine is when a child has to have sutures.

We use a fair amount of propofol, also ketamine, in addition to all the usual suspects (midazolam, fentanyl, etc.) In addition to objective indications, docs each have their preferences like in other things.

#1) Etomidate
#2) Ketamine
#3) Propofol
#4) Versed & Fentanyl

We always have patients on the monitor with RT and MD at the bedside, VS q5min, RN at bedside post-procedure until LOC is baseline. I like Etomidate and Propofol the best...much easier recovery and more predictable sedation.

We use a lot of etomidate for concious sedation, and also for intubation.

We rarely do conscious sedation in our ER but if we do it's done by our CRNA. If it's actually being done in the ER that patient is probly being stabilized to go to a bigger hospital since we are small and rural. I think he uses Propofol often.

This ER I work at now, anesthesia comes down for the sedation part. Didn't like it at first because I felt left out. But now hey it's less work for me.