Emergency Department Clinical Pathway
for Procedural Sedation
Related Pathways
- Burn Injury, ED
- Cellulitis/Abscess, ED and Inpatient
- Dental Trauma or Infection, ED
- Fracture, Extremity, ED
- Fracture, Open Long Bone, ED
- Laceration, ED
- Neck Space Infection, Deep, ED
- Preparing Children for Anesthesia/
Sedation, ED and Inpatient - Septic Arthritis, ED
- Ventricular Shunt Obstruction/Infection,
ED, ICU, Inpatient
- Determine Level of Sedation Required
- Painless procedure, anxiolysis
- Painful procedure, local/regional anesthesia
- Painful procedure
- Obtain verbal consent
- Policy: ED Procedural Sedation
- Indications for Admission
- Sedation related:
- < 28 days (FT)
- < 60 wks post-conceptual age
- Need for further monitoring
- Other medical/surgical reason for admission
Anesthesia Consult
- ASA 4/5
- Known or suspected difficult airway based on exam or syndrome, history of or active airway obstruction (severe OSA, active croup)
- Clinical concern for increased intracranial pressure with urgent procedure
- Ongoing emesis
Consider Anesthesia Consult
- ASA 3
- Age less than 1 yr
- Chronic lung disease
- C-collar in place
- Impending OR for other procedure
- Status epilepticus or poorly controlled seizure disorder
- Acute asthma exacerbation requiring frequent bronchodilators
- Severe autism/behavioral issues
- Resource requirement
- Complexity of procedure, pain, amount of sedation medication required
- Impaired GI motility syndromes
Cardiology Consult
For all other cardiac patients requiring procedural sedation, consult Cardiology or Cardiac Anesthesia as clinically indicated
- Review last Cardiology Clinic note
- Examples that are appropriate for ED sedation
- Repaired isolated PDA, ASD, VSD, coarctation with no hemodynamic or electrophysiologic compromise
- Resources for Sedation Emergencies
Evidence
- Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children
- Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016
- Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update.
- Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology
- The Newest Threat to Emergency Department Procedural Sedation
- An International Multidisciplinary Consensus Statement on Fasting Before Procedural Sedation in Adults and Children