Cite this post as:
Scott Weingart, MD FCCM. Practical Evidence 014 – ACEP Procedural Sedation Update for 2013. EMCrit Blog. Published on February 18, 2014. Accessed on December 11th 2024. Available at [https://emcrit.org/emcrit/acep-procedural-sedation-update-2013/ ].
Financial Disclosures:
The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.
CME Review
Original Release: February 18, 2014
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027
You finished the 'cast,
Now Join EMCrit!
As a member, you can...
- Get CME hours
- Get the On Deeper Reflection Podcast
- Support the show
- Write it off on your taxes or get reimbursed by your department
.
Get the EMCrit Newsletter
If you enjoyed this post, you will almost certainly enjoy our others. Subscribe to our email list to keep informed on all of the Resuscitation and Critical Care goodness.
This Post was by the EMCrit Crew, published 11 years ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.
Hey Dr Weingart,
Prehospital Ketamine, yea or nay? I’m a Paramedic Intern in the Boston area, and around here, we don’t even have a whiff of Ketamine. Dr Minh Le Cong of PHARM seems to love the stuff, and as far as I can tell, it seems like a great agent to use prehospitally, with it’s cardiovascular stability and multitude of uses. Thoughts on prehospital sedation and induction would be much appreciated too, if you’ve got the time.
Gratefully,
Sylvain Ellis
Paramedic Intern
to my mind it is a drug purpose built for the prehospital environment
Thanks for another great podcast Scott.
Does this mean that you would you do electrical conversions for atrial fibrillation without symptoms of acute heart failure without a full preprocedural fasting? These patients are usually not in pain and often only mildly symptomatic. A full preprocedural fasting prior to el-con is hospital policy in most (if not all) Scandinavian hospitals.
if I decide to go down that road, yes, I’d have no problem ignoring last meal. If I was admitting them regardless, then it is a toss up. But like I alluded to in the cast, just choose your meds based on the situation. El-con is nice b/c they are sitting up, less chance of passive regurg.
Thanks for another interesting podcast Dr. Weingart.
Whats your take on sedating a child via the intranasal route: Intranasal midazolam vs intranasal ketamine vs intranasal dexmedetomidine? I’m an emergency medicine resident, working in the middle east.
no exp. c peds unfortunately
Thanks for the POD cast
So according to the ACEP Clinical Policy:
“Propofol can be safely administered to children and adults for procedural sedation and analgesia in the ED.”
Propofol? An analgesic? Surely they don’t mean that.
Hi Dr. Weingart,
Since propofol is level A recommendation by acep where ketamine in adults is level c, if patients blood pressure is stable and you are doing a quick ortho procedure, should we be using propofol instead of ketamine due to the level of evidence?
Also, how much O2 are you suggesting for pre-oxygenation and for how long before procedural sedation?
Thanks 🙂
Paul, Although I agree in concept with the recommendations put forward, I was a little dismayed by your apparently flip take on pre-existing fasting guidelines and the idea that you “might” have some added concern for someone who just ate six cheeseburgers before administering procedural sedation. Another point of view on what are essentially different risk tolerances: Aspiration is a low frequency, high acuity event. As Marik’s paper reports (N Engl J Med 2001; 344:665-671) aspiration can be a major cause of airway-associated morbidity and mortality. In particular, “It is also a recognized complication of general anesthesia, occurring in approximately… Read more »