REMSTARBC.ca    Rural Emergency Medicine Simulation Training and Resource - British Columbia
Any physician working in the ER should be very familiar with procedural sedation.
There are a number of medications that have been used historically and currently.
Which ones you actually chose to use is not as important as knowing the onset,
duration, side effects and efficacy of these medications.

Use of a Procedural Sedation Checklist can not be overemphasized.

Procedural Sedation Checklist

Pre-Procedure Assessment
_____ Past medical history (note history of OSA) ______________________________
_____ Prior problems with sedation/anesthesia _________________________________
_____ Allergies to food or medications ______________________________________
_____ Procedure _______________________________________________________
_____ Dentures   none   /   upper   /   lower [should remain in during PSA unless intubation required]
_____ Cardiorespiratory reserve   no or mild impairment /moderate impairment / significant impairment
_____ Difficult airway features      none   /   mild concern   /   significant concern|
_____ Weight (kg) ________                                                            
_____ Benefits of proceeding with PSA exceed risks

 Difficult Airway Features:
Difficult Laryngoscopy:   Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction,
                                          Neck Mobility
Difficult BVM Ventilation: Beard, Obese, No teeth, Elderly, Sleep Apnea / Snoring
Difficult LMA:  Restricted mouth opening, Obstruction, Distorted airway, Stiff lungs or c-spine
Difficult Cricothyroidotomy: Surgery, Hematoma, Obesity, Radiation distortion, other deformity, Tumor*
Is this patient a good candidate for ED procedural sedation and analgesia?
The less cardiorespiratory reserve, the more difficult airway features, and the less procedural urgency,
      the more likely the patient should not receive PSA in the emergency department.
If not a good candidate for ED-based PSA, other options include regional or local anesthetic;
     PSA or GA in the operating room; or endotracheal intubation in the ED.

 Emergency Department Procedural Sedation and Analgesia Physician Checklist
_____ Analgesia - maximal patient comfort prior to PSA
_____ Informed consent for PSA and procedure
_____ Patient on monitor: telemetry, NIBP, SpO2, EtCO2
_____ Oxygenate with Nasal Cannula and high flow face mask O2 or non-rebreather mask 15 lpm
_____ Select and draw up PSA agent(s)
_____ Reversal agents and paralytic vials at bedside
_____ Prepare for endotracheal intubation

 Pre-procedure Preparation
Airway Equipment
_____ Ambu bag connected to oxygen
_____ Laryngoscopy handles and blades
_____ Suction
____ Oral & nasal airways
_____ Endotracheal tubes & stylets
_____ LMA with lubricant and syringe
_____ Colorimetric capnometer/EtCO2 monitor
_____ Bougie & difficult airway equipment