conscious sedation

My facility's policy is that Diprivan can only be used on an intubated patient. The most common drug combo we use for moderate sedation is Versed & Fentanyl.

Do you use Diprivan (Propofol) for conscious sedation in your ED? If so, who administers it?

A valid question with a complex answer.

What exactly are the definitions of Conscious Sedation? Read over it and see if the definition of CS matches what happens when you give propofol to a patient in the ED.

You tell me if this is indeed CS.

We use propofol quite frequently for conscious sedation in our ED. I have never pushed it, it has always been administered by an MD in cases I have been involved with, because I was under the impression that only an MD or CRNA could push propofol. However, my charge nurse, who overheard me telling this to another nurse informed me that RN's in our ED coud give propofol if we had attended the yearly conscious sedation inservice. Big surprise to me. Just wondering how other ED's handle conscious sedation.

We use it sometimes, pushed by the RN. I'm okay with that since the doc is right there with me.

how little you know will hurt you.

how little you know will hurt you.

Not sure what this response is supposed to prove--if you have a point MAKE IT!

In our ED we mostly use Etomidate d/t the short half life and increased safety compaired to other drugs.

I personally would not push Propofol unless I had some specific education on it.

This is the first that I've seen Etomidate mentioned here. I was given Etomidate in ER for a "spinal tap" for suspected meningitis when I told them I have always been terrified of an needle anywhere near my spine and would most likely hit the ceiling the minute I felt them swab my back in preparation plus I knew we couldn't use Versed as I'd had a reaction and gotten agitated and hostile when we tried that for a colonoscopy. The ER doctor used the Etomidate and I woke up as he was drawing the third of four vials w/absolutely no problems. And no panic!

In my ED we only use Diprivan to keep an intubated pt. sedated and we hang a drip that is titrated. As an LPN I hang this frequently. I have been an ER nurse for 17 yrs. now. We use fentenal, etomidate and versed, also Katemine (I love this for kids if the doc orders the right dose to sedate them!) for consious sedation. And of course we use Demerol and Phenergan, or some other narcotic to enhance the process.

Usually each facility should have policy in place to define conscious sedation and who can administer what. At ours, any use of diprivan for procedures can only be administered by those certified to push anesthetic agents, (which is usually anesthesia or CRNA). In ED, physicians are present when other sedatives/pain meds given for procedures, and documentation is specific for that.

In my ED we only use Diprivan to keep an intubated pt. sedated and we hang a drip that is titrated. As an LPN I hang this frequently. I have been an ER nurse for 17 yrs. now. We use fentenal, etomidate and versed, also Katemine (I love this for kids if the doc orders the right dose to sedate them!) for consious sedation. And of course we use Demerol and Phenergan, or some other narcotic to enhance the process.

- fentanyl

- ketamine

fentanyl & ketamine for CS

Succs and etomidate for RSI