concious sedation

[gasolino]

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how are you guys using concious sedation for procedures? my residency is severely underusing them, especially in our peds ED. We papoosed most of the pts. Lack of nurses, our Peds ED only get 2 nurses (meaning only 1, one is always on break for some reason). one councious sedation or medical not or trauma, make the residents become honorary nurses (we push IV meds, put IV, draw blood, PLACE FOLEYS, sometimes transport our own pts to get radiology stuff, and at all time we have to change the damn bed sheet ourself)........ but yeah i love my urban ER =). But honestly i wish we reduce the amout of papoose use and stop asking the dads to hold their 3 yr old head whose wrapped up in papoose so i could suture his chin lac.

 

[roja]

how are you guys using concious sedation for procedures? my residency is severely underusing them, especially in our peds ED. We papoosed most of the pts. Lack of nurses, our Peds ED only get 2 nurses (meaning only 1, one is always on break for some reason). one councious sedation or medical not or trauma, make the residents become honorary nurses (we push IV meds, put IV, draw blood, PLACE FOLEYS, sometimes transport our own pts to get radiology stuff, and at all time we have to change the damn bed sheet ourself)........ but yeah i love my urban ER =). But honestly i wish we reduce the amout of papoose use and stop asking the dads to hold their 3 yr old head whose wrapped up in papoose so i could suture his chin lac.

Our peds ED uses Nitrous. Also po versed. ketamine is nice as well. LET fro suturing. Personally, I prefer the papoose for many of the reasons you stated, but also because even 'safe' sedation has risks. I give parents the option. My kid was papoosed. She wasn't scarred for life...

 

[southerndoc]

We use ketamine and midazolam. We do papoose a lot of patients (quicker turnaround time), but we have a very good nursing situation. There are so many nurses in our pediatric ED that it's unbelievable. It's no more than a 2 patient:1 nurse ratio.

 

[roja]

We use ketamine and midazolam. We do papoose a lot of patients (quicker turnaround time), but we have a very good nursing situation. There are so many nurses in our pediatric ED that it's unbelievable. It's no more than a 2 patient:1 nurse ratio.

where do you work? 😱

 

[southerndoc]

where do you work? 😱

Yale. Seriously, there are so many nurses on the pedi side that it's unbelievable. The same isn't true on the adult side though. I forgot to mention that in addition to all the nurses, there are about 3 or 4 techs and a child life specialist there. There are usually 2 or 3 nurses in triage, 1 or 2 for resource (float nurse), 3-5 for the patient care area, and 1 doing charge.

 

[USCDiver]

From a private practice standpoint, I will papoose any child that I can. It takes no less than 30min to prepare for a procedural sedation and another minimum 30min of recovery time. That's a whole hour of time dedicated to a 5 minute procedure!

Obviously, some children do require sedation: fracture reductions, complicated lacs, can't hold still for imaging, etc. But I avoid it if at all possible.

 

[EM2BE]

totally not ED related, but I have thought about the sedation factor for my sister (special ed, terrified of docs because of her brain surgeries) for simple things, like when she has to get her first pelvic exam. She already gets sedated for all dental procedures and her EEGs every year, and I'm hoping they can tie one of those sedations with the pelvic. As we view it, it's not the risks of sedation that worry us, it's her needing increasing doses in order to go out. She has maxed out before and was still awake, so they made us take her back another day for the sedation and they would try a different combination.

I guess my final point would be that if a person gets sedated too often, that can also cause a big problem (but hopefully they aren't frequent flyers at that age yet).

 

[tegs15]

As a father and med student, if the Doc can take the yelling I would rather hold them still, then add the increased risks associated with sedation. Actually I held my 18mo son's head last week while they placed sutures in his 3cm lac running across the bridge of his nose. The Doc showed me a trick by putting his stethoscope on as psuedo-earplugs, that one I'll have to remember. I don't know if my opinion would change if it was a reduction w/o sedation or at least prophylaxis pain management.