Conscious Sedation in the ER

  1. I am interested in knowing what medications are used in your emergency department for conscious sedation. Do you use drugs such as Etomidate? Ketamine? Do these fall under your facility guidelines for conscious sedation? Should these drugs be used in the ER?
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  2. 28 Comments

  3. by   CHUBBY
    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.
  4. by   CTURNEY
    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.
  5. by   countessvonH
    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
  6. by   perfectpicture
    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.
  7. by   Medic09
    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.
  8. by   Larry77
    #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.
  9. by   travelcrazyRN
    We use a lot of etomidate for concious sedation, and also for intubation.
  10. by   nkochrn
    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.
  11. by   mmutk
    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.
  12. by   rjflyn
    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.
  13. by   Jenifer819
    I work in Peds ER. I have seen Versed and Ketamine used.
  14. by   Pat_Pat RN
    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.

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