Procedural Sedation & Analgesia

In this episode, Sam Ashoo, MD interviews Prayag Mehta, MD and Joshua Kern, MD - two of the authors of the June, 2022 EMP article on Procedural Sedation and Analgesia in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to sedation in adults and pediatrics ! Procedural Sedation and Analgesia in the Emergency Department https://www.ebmedicine.net/topics/emergency-procedures/emergency-medicine-procedural-sedation EMplify - June 2022 Episode Outline: Procedural Sedation and Analgesia (PSA) - TerminologyLevels of sedationMinimalModerateDeepGeneral AnesthesiaPrehospital careED care - Patient assessmentASA class system Complications: these can be minor or major, and most are minor and easily handled by the EM physician?Equipment needed (Table 1 checklist) What is the Larson maneuver (Figure 2)Procedural TechniqueWhat is the current ACEP (and AAP) recommendation on this? Is there good data for 1 or 2 physician sedation? Pre-procedural FastingDo we even need to consider this in PSA?CapnographyOxygen supplementationOnly use when capnography is present.Pre-procedural Opioids - are they safe? do they reduce sedation needs? what's the ideal timing? Pre-procedural Sedatives-  are they safe? do they reduce sedation needs? do they help with agitation? Anticholinergics - is there evidence for their benefit in adults or peds? Antiemetics - before the procedure? after? only as needed? Treatment - Table 2 Fentanyl Remifentanil Midazolam Nitrous Oxide PropofolKetamineKetofolEtomidateReversal AgentsNaloxoneFlumazenilSpecial PopulationsPediatricsPregnancyGeriatricsCutting Edge - would you like to discuss any of these? Dexmedetomadine https://foamed.ebmedicine.net/rapid-reference/procedural-sedation-medications/