Quote from buck227
I have administered alot of concious sedation in the ER and in the ICU. The key to know where the line is as far as what is anesthesia's responsibility and where your privaleges stop is in your hospitals policy. It is very important your are familiar with this prior to giving any sedation. There are fine lines. I have seen policies against fentanyl and I have seen them also omitted. If you go outside your hospitals policy, then you are on your own. You can be subject to charges such as practicing medicine without a license and nursing malpractice or negligence. I have seen physicians push nurses to do things out of their relm just for their own convenience. Be very careful!
Now, If you are giving concious sedation, you should have no other duties other than patient monitoring. You need to have the appropriate antidotes and be familiar with them. Although it is not required in many places (it should be) you should also have recieved training in ACLS. A crash cart must be close by with appropriate airway management equiptment. The patient must be hooked to a monitor and pulse oximetry.
I have seen 2mg versed be too much for a 200LB young male and I have seen 65 yo ladies take 15-20mg and remain awake. Versed is a very individual-dose type of drug. It is also very effective.
I hopes this helps. Let me know if I can be of any further assistance.
Hi Buck: I am an RN. I have go for cautery endoscopy every six months for a rare disorder, AVM of the stomach or "watermelon stomach." I started out with this about 2-3 years ago when it developed and had severe anemia. The condition has been well controlled but is something I have to have for life. My concern now, does a doctor have to be present when conscious sedation is given? My concern arose when one of my last endoscopies, 2 nurses, I assume gave me my sedation medication and I started having s.o.b. Although they claimed my sats were 100 % and just pushed the rest of the medication. They apparently did not tell the doctor, and I forgot to tell him under the influence of the sedation. I did, the next day, report this incident to his nurse. Assuming any doctor wanted to be told of any problem, he became angry and defensive. Apparently he ordered an extra dose of 50 mg IV Benydrel that had caused my reaction. His nurse referred me to the manager of the endoscopy center. We talked and ended it by asking that the doctor to be in the room when medication was given. He was very sullen and there was no discussion with him the next endoscopy. Only a nurse stating "you won't be given any more IV Benadryl." Today, I was left in a very cold holding area for 1 hour and 45 minutes before they even took me in for my procedure. I was so cold I started to cry and called for a nurse. I could not find my call bell. When I was finally taken in for the procedure, I was told by 2 staff members, that they were "techs." 2 staff members who did not identify themselves showed me syringes of medication. I never saw the doctor any place, but of course he could have been standing behind me, so I could not really prove he was not in the room.
I am thinking that I would try to get another doctor to perform my endoscopy cauteries. But I started thinking how difficult this would be with the years this doctor had been treating me. Even with another "corporate" hospital, they would have to have my history as documented for treatments.
Would it be a good idea to get a copy of my medical records and read their documentation before I looked for a new doctor so I would know what I would be up against. Even though I would try for another hospital corporation doctor, I am sure they would want to know why I wanted to try and change doctors. As is well known, doctors all protect their own.
I don't want to get into any legal entanglements. I would only want to drop this corporation and go to another.
Any information you can throw my way, I would truly appreciate.