Sedation and Procedures
Emergency physicians routinely provide sedation and analgesia, monitor the respiratory and cardiovascular status and manage critically ill patients of all ages. The provision of safe and effective sedation and analgesia is an integral part of emergency medicine practice. Failure to adequately treat a patient’s pain can have negative consequences, the event potentially affecting later physiologic responses and behaviors. Appropriately treating pain and anxiety decreases patient suffering, facilitates medical interventions, increases patient/family satisfaction, improves patient care and may improve patient outcome.
Our emergency department has been a pioneer in the “Ouchless ED” philosophy. Proactive steps are taken long before any procedures to minimize anxiety and create a calming environment, and family members are encouraged to hold their children for comfort throughout procedures. Oral narcotics can be given by our nurses in triage to expedite pain relief long before the patient is ever seen by a physician. Buffered injectable lidocaine and distraction is used with every IV start. Sucrose is used for neonates immediately before and during painful procedures.
Nitrous gas is encouraged for use during simple procedures, obviating the need for IV access, itself an additional cause of pain and anxiety as well as causing delay in treatment and disposition. During deep sedations with ketamine, a specially trained nurse or medic assists the sedation physician with set-up and vital sign charting, allowing the physician to focus all attention on the patient. Our emergency department has advanced the practices of using nitrous gas during hematoma block placements in fracture reduction, as well as the efficacy and safety of rapid-push Ketamine during sedation.
All procedures, including splinting and suturing, are performed by physicians or NP/PAs. Procedural competency is a hallmark of our fellowship training program and fellows’ shifts are structured to allow ample time and experience with all procedures performed in the ED.