SCARED to death of conscious sedation

[b eyes]

Can anybody boost my confidence with experiences/ knowledge about conscious sedation? We frequently do it in our ER, although I haven't done it yet. We generally work alone in the ER with one nurse and one doc, so I need to be prepared. Generally the med is valium or versed. I have given valium once before but never versed. A nurse doing colonoscopys gave versed and the patient coded! I have read about them but is there anything more you can share that books don't tell? and sometimes its done on childeren or adolescents, sometimes adults and sometimes elderly. just depends who has the injury. All these different ages with different comorbidities......ahhhhhh

b eyes

[justme1972]

I had to have a minor surgery when I was 19 years old (female kind), and they used valium, and I too, was absolutely terrified because I would be "awake".

Everyone reacts differently to drugs, but what I didn't realize, is that the dosage was so high, I just "woke up" in another room, even though I had been awake the entire time....I just had no recollection of the procedure. I remembered acting really silly, being severely nauseated. Other than that..I was fine.

[NativeSundance, LPN]

We use Etomidate on adults ALL the time. Just did it a few hours ago again for a shoulder reduction. Kids get Ketamine IM. I've never had the experience of kids having problems coming out of it. They just wake up quietly and get through the experience without trauma or fear.

[Noryn]

In the ER where I used to work, there were only 2 nurses in the best case scenario unless the nurse manager was working. At nights there was only 1 nurse so 2 nurses assisting with a procedure was just about impossible. We did call resp therapy though and they handled the o2 and any airway issues.

The rule of thumb as other have mentioned is to push these things slow, use the drug book as your guide. I always used a paper towel to note vitals and what time I was pushing what. Usually I didnt have to push too much, I did my initial push of meds then assisted the doctor. Most of our conscious sedation was on displaced shoulders in adults, we never did anything with children.

[mom2michael, MSN, RN, NP]

In the ER where I used to work, there were only 2 nurses in the best case scenario unless the nurse manager was working. At nights there was only 1 nurse so 2 nurses assisting with a procedure was just about impossible. We did call resp therapy though and they handled the o2 and any airway issues.

The rule of thumb as other have mentioned is to push these things slow, use the drug book as your guide. I always used a paper towel to note vitals and what time I was pushing what. Usually I didnt have to push too much, I did my initial push of meds then assisted the doctor. Most of our conscious sedation was on displaced shoulders in adults, we never did anything with children.

We only have 1 RN 24/7 and an overlap RN from 11-11....so I'm in the same boat as you - my best case would be to have 2 RN's but that isn't always likely or possible. But you are lucky to have RT - we don't have RT after 1700. You could call Radiology or Lab to come in and help the doc if your tech was tied up.....but that's about it.

We don't do kids - they get shipped. We only do stable adults and usually nothing more than reductions. We use Etomidate now because of the quick 1/2 life.

I have to say that in my almost 2 years in my ER as a tech and now an RN I've only seen/assisted with less than 10 conscious sedations.

[PANurseRN1]

First of all, you shouldn't be doing conscious sedation without two nurses present: one to solely monitor the patient and the other to assist with the procedure. One nurse and one doc in the ER isn't enough to adequately do conscious sedation. And then the question becomes what happens if a code comes in at the same time?

Secondly, once you get adequately staffed or can have trained assistance, doing conscious sedation frequently allows for a higher comfort level.

Geez...thanks! I was reading the previous replies thinking I was was a worrywort or something. I've never done C/S where there haven't been at least two RNs, and I just work in a dinky little community ED.

ETA: I have never given propofol for C/S, and I never will. That's an anesthesia med in my mind, and as of right now, unlike benzos, there's no reversal agent, so if you overshoot your mark...oops!