Conscious Sedation in the ER

[Silktea3]

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?

[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.

[GleeGum, BSN, RN]

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

[Lunah, MSN, RN]

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.

[Christy1019, ASN, RN]

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.

[one_speed]

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...

[TaraER-RN]

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!

[rgroyer1RNBSN, BSN, RN]

We use versed, and fentanyll or demerol sometimes propofol.

[JessicRN]

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.

[Lunah, MSN, RN]

We're only allowed to use propofol in a drip (after intubation), never a bolus/IVP.

[JessicRN]

It is not so much the medication as who gives it. Many board of nursing state only a physician can administer these medications and it is not within our scope of practice to give it for moderate sedation. We at first got an email by our director saying we cannot administer it but we can monitor it. Then they say we can administer it but only an emergency MD attending can do moderate sedation in our ED

[canoehead, BSN, RN]

For a lot of the high test sedations the nurses draw up the drugs but the docs actually push the med, taking liability off our shoulders. The one time I was asked to push propofol I declined, doc said, "just trust me and give it." "Famous last words..." I said, and there was no more coaxing, he gave the med, I wrote it down, and all remains well in the kingdom.

[meluhn]

We used po versed and chloral hydrate on kids in a clinic setting (not at the same time). Never had a problem except for one time a kid had paradoxical reaction to the chloral hydrate and got all hyper. I dont think I really appreciated at the time how wrong things could have gone because we never had a bad problem.