Giving comfort amidst chaos

In an acute care setting, sedation takes on new urgency.

The top two reasons for emergency department visits in the United States in 2013 were abdominal pain and chest pain. Back pain and headache also appeared among the top 10 reasons.([FOOTNOTE=Rui P, Kang K, Albert M. National Hospital Ambulatory Medical Care Survey: 2013 Emergency Department Summary Tables. U.S. Department of Health and Human Services.],[ANCHOR=],[LINK=])

Patients who need immediate care and sedation for diagnostic or therapeutic procedures can present their own set of challenges. 

Sedation in the Emergency Department

Balancing procedural urgency and risk

No incidences of aspiration in 1,014 procedures. There were no incidences of aspiration during procedural sedation in children in the ED.([FOOTNOTE=Agrawal D, Manzi SF, Gupta R, Krauss B. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 2003 Nov;42(5):636-46.],[ANCHOR=],[LINK=])

Aspiration during procedural sedation is rare but potentially fatal when it occurs. Clinicians can assess risk in individual patients, balancing oral intake against the urgency of the procedure and determining the lightest level of sedation appropriate.([FOOTNOTE=Green SM, Roback MG, Miner JR, Burton JH, Krauss B. Fasting and emergency department procedural sedation and analgesia: a consensus-based clinical practice advisory. Ann Emerg Med. 2007;49(4):454-61],[ANCHOR=],[LINK=])

An additional 60 seconds

60 seconds median warning time of hypoxia when monitoring with capnography.4

100% accurate predictions of hypoxia when monitoring with capnography.4

Using capnography, clinicians detect respiratory depression before hypoxia occurs. Because clinicians can intervene sooner, the rate of hypoxic events with capnography decreases by 17 percent, compared to standard monitoring (pulse rate and rhythm, respiratory rate, blood pressure, and pulse oximetry).4

Breathing Easier

19% vs 41% hypoxia incidence.

Patients using high-flow oxygen versus compressed room air.6

Patients received either 100% oxygen or compressed room air at 15 L/minute by a nonrebreather mask for five minutes before and during procedural sedation.6

Patients receiving high-flow oxygen experienced significantly less (23%) hypoxia than patients receiving compressed room air.6

Adjusting sedation, improving satisfaction

In a study, undergoing orthopedic procedures and receiving pre-sedation opioids decreased patient satisfaction, while deeper sedation levels during the operation increased it.7

Good sedation decisions with limited information

There is no single agent or combination of agents for every patient or sedation procedure. Emergency physicians and staff are expected to be familiar with the pharmaceutical agents they use and be prepared to manage their potential complications, including converting to intubation and general anesthesia if necessary.([FOOTNOTE=American College of Emergency Physicians. Policy Statement: Sedation in the Emergency Department. January 13, 2011. Retrieved May 2, 2017.],[ANCHOR=],[LINK=]),3 The American College of Emergency Physicians recommends capnography for patients receiving procedural sedation in the emergency department.10