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

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10 Ways to Safely Push Ketamine in the ED

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  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

 

Being Human…

Procedures done in the Emergency Department are really painful. Research done in Kenya (READ MORE) showed that we’re doing loads of these but anecdotally the patients received minimal analgesia. Stop the SCREAMING…learn Procedural Sedation and Analgesia…it’s easy and more humane

When you have to put the child to sleep for a painful procedure

When dosing oral midazolam for anxiolysis – like when you’re doing a procedure – you can dose above the listed limit of 0.5 mg/kg. In fact, you can dose up to 1 mg/kg!

For the child who is preschool and under I will typically give the following dose: 0.7 to 0.8 mg/kg

DO NOT FORGET THE PAIN KILLER!