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Emergency Department Procedural Sedation and Analgesia Physician Checklist
Emergency Department Procedural Sedation and Analgesia Physician Checklist
Physician 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
☐ Last oral intake (see fasting grid on reverse) _____________ ☐ Will delay procedure until _________
☐ Weight (kg) ________ ☐ Benefits of proceeding with PSA exceed risks
[patient label]
Post-procedure Assessment
☐ Adverse events none / hypoxia (< 90%) / aspiration / hypotension / agitation / other: ____________________________________
☐ Interventions taken none / bag valve mask / LMA / ETT / reversal agent / hypotension Rx / admission for PSA / other: _____________
☐ Adequacy of PSA nondistressed / mild distress / severe distress
☐ Procedure successful / unsuccessful
☐ MD or RN at bedside until patient responds to voice
☐ Telemetry, EtCO2, SpO2 monitoring until patient responding to questions appropriately
☐ If reversal agent used, observation two hours after answering questions appropriately
☐ Mental status and ambulation at baseline at time of discharge/disposition
Fasting Grid
Standard risk patient** Higher-risk patient**
Oral intake in the Emergent Semi-urgent Non-urgent Oral intake in the Emergent Semi-urgent Non-urgent
Urgent Procedure Urgent Procedure
prior 3 hours Procedure procedure procedure prior 3 hours Procedure procedure procedure
All levels of All levels of
All levels of All levels of Nothing All levels of sedation All levels of sedation
Nothing All levels of sedation All levels of sedation sedation sedation
sedation sedation
Up to and including
Up to and including All levels of Up to and including Minimal sedation
All levels of Up to and including Clear liquids only extended moderate
Clear liquids only All levels of sedation extended moderate sedation brief deep sedation only
sedation
sedation brief deep sedation
sedation Up to and including
Up to and including dissociative
All levels of Minimal sedation Minimal sedation
dissociative Light snack sedation; non-
All levels of Up to and including Minimal sedation sedation only only
Light snack sedation; non- extended moderate
sedation brief deep sedation only sedation
extended moderate
sedation Up to and including
dissociative
Up to and including Heavier snack or All levels of Minimal sedation Minimal sedation
Heavier snack or All levels of Minimal sedation Minimal sedation sedation; non-
extended moderate meal sedation only only
meal sedation only only extended moderate
sedation sedation
Additional Comments
*Walls RM and Murphy MF: Manual of Emergency Airway Management. Philadelphia, Lippincott, Williams and Wilkins, 3rd edition, 2008
**Green, Roback et al. Fasting and Emergency Department Procedural Sedation and Analgesia: A Consensus-Based Clinical Practice Advisory.
Ann Emerg Med. 2007;49:454-461. R. Strayer / P. Andrus emupdates.com 11.28.2013