Procedural Sedation Errors

Procedural Sedation Errors

Error #1: Delaying deep sedation until fasting times are met

Error #2: Believing PSA carries less risk than endotracheal intubation

Error #3: Minimizing risk of airway and breathing complications while using ketamine

Error #4: Not having full intubation setup nearby

Error #5: Responding to hypoventilation or apnea with early and/or aggressive use of the bag-valve mask (BVM)

Error #6: If the oxygen saturation is ok, then the patient is breathing ok

Error #7: Withholding ketamine sedation on adults

Error #8: Adding an opioid with ketamine for sedation

Error #9: Using the same dosing strategy for propofol sedations as with fentanyl/midazolam

Error #10: Using the same PSA dosing strategy for the elderly


10 Ways to Safely Push Ketamine in the ED


  1. Push Ketamine for Analgesia
  2. Consider Ketamine for Procedural Sedation
  3. Reach For Ketamine in Rapid Sequence Induction (RSI)
  4. Dilate in Asthma
  5. Sedate Post-Intubation
  6. Keep It Handy as a Tranquilizer
  7. Manage Ketamine’s Psychiatric Distress
  8. Remember the Cardiac Factor
  9. Lock it Down: Prevent Abuse
  10. Limit Risks of Laryngospasm, Hypertonicity, Hypersalivation


Quick Tip: Finger tip dermal avulsion injuries

Fingertip InjuriesQuick Tip: For finger tip dermal avulsion injuries the first step in caring for any minor wound is controlling the patient’s pain. As a means of anesthesia, have the patient dip the injured finger in 1% lidocaine with epinephrine for 5 minutes. One can pour 10-20 cc of this solution into a small medicine cup or urine specimen cup, and the patient simply soaks the afflicted finger. Epinephrine has the added benefit of vasoconstricting the troublemaking-little bleeders