What do you use for conscious sedation in your ER ?

[BunkyRN]

I was wondering what other nurses use for their bedside conscious sedation. Where I am at we are no longer allowed to push propofol. So we end up using etomidate often. I have a friend who is a CRNA and he thinks thats just nuts ! Just curious - Thanks

[Zaphod, BSN, RN]

Etomidate?Thats crazy-Im sorry. Thats not even sedation-just paralysis. Geez. Im sure you can give Ativan, Versed, Morphine and other good stuff. No RN is EVER allowed to push propofol as common as this practice is. That constitutes practice pf anesthesia.

[AnnieOaklyRN, BSN, RN, EMT-P]

Etomidate?Thats crazy-Im sorry. Thats not even sedation-just paralysis. Geez. Im sure you can give Ativan, Versed, Morphine and other good stuff. No RN is EVER allowed to push propofol as common as this practice is. That constitutes practice pf anesthesia.

Etomidate is sedation, and it does not paralize!

[AnnieOaklyRN, BSN, RN, EMT-P]

Depends on the Dr.

For kids under 2ish we use Ketamine and sometimes versed with fentanyl

For adults we use either versed with fentanyl or propofol. We are allowed to push the Propofol where I work as long as the MD is in the room when we do it.

Happy

[Zaphod, BSN, RN]

Etomidate is sedation, and it does not paralize!

You are correct I got confused with Succ-however it is still an anestheisa adjunct and can cause apnea, without any anelgesic properties. Never seen it used for anything other than intubation or anesthesia.

[murphyle, BSN, RN]

Depends on the case. For infants and toddlers, we typically use ketamine; on older kids we'll use morphine and Versed, and then etomidate as the induction agent. Likewise, adults usually get either morphine or Dilaudid followed by etomidate. Zofran also commonly gets added to the scheme for coverage of post-procedural nausea and vomiting.

RNbyDesign: Ketamine is pretty much the only agent mentioned in this thread that doesn't significantly depress respiratory drive. That's why we always do our procedural sedations in the resus bay, why we always have a BVM with 100% O2 ready to go, and why everyone gets put on some O's prior to induction. (Kids always get a nonrebreather; adults can go on a nasal cannula or a NRB at the MD's discretion.)

[BunkyRN]

Thanks for the responses..

We always have the MD in the room for sedation, and it is funny that we NOW cant push propofol, but the doctor can... even though the doctor is in the room. Well, when I worked in SICU, we titrated our propofol and it wasn't locked up like PCA's or epidurals were.. but that was 5 yrs ago.

Do you think the whole Michael Jackson thing stirred this one up, or am I just dreaming ? haha

[MesaRN]

We use propofal nearly exclusively for conscious sedation. New literature is showing promise with propofal/ ketamine combo for adults. A few EDPs use it and the combo has been the best conscious sedation agents I have used in terms of quick onset, quick out, and less resp depression.

As mentioned above we have full cardiac monitor, BVM, crash cart/ airway cart, and 02 on the pt. during all sedations.

[GM2RN]

Fentanyl and versed only. We will do some older children but we would transfer any infants or toddlers needing conscious sedation.

[silentRN]

We can't push Propofol either. We'll lose our license if you get caught doing that.

[Larry77, RN]

No RN is EVER allowed to push propofol as common as this practice is. That constitutes practice pf anesthesia.

This is an untrue statement. It depends on your state, check your BON. Some states allow it others do not.

[Lunah, MSN, RN]

What we use depends on the doc, and why we're doing the sedation (reduction, suturing, etc.). I'd have to say we use Etomidate more often than anything else ... but other than that, maybe Versed + Fentanyl, Versed + Dilaudid, Valium + Dilaudid, etc. We sometimes use Ketamine for younger kids.