Safe Sedation Procedures in Adults Case 3

1. Question

An 80-year-old female has presented to the ED with shortness of breath, mild chest pain and palpitations. She is fully orientated and alert. She is currently in the resuscitation room.

The following observations can be seen on the monitor at her bedside (Click on the ECG showing ventricular tachycardia to enlarge).

Pulse 200
Blood pressure 80/55
SaO₂ 90% on air

You decide that you need to perform synchronised DC cardioversion; your supervising consultant emergency physician is currently employed in minors.

Which answer best describes the most appropriate immediate management?

Perform a focussed history, examination, provide oxygen, obtain intravenous access and attach the patient to a cardiac defibrillator/monitor
Perform a focussed history and examination then transfer the patient to the treatment area to await arrival of the anaesthetist
Call the consultant and perform a focussed history, examination, provide oxygen and obtain intravenous access. Connect the patient to a cardiac defibrillator/monitor and await the arrival of the summoned consultant emergency physician
Call the consultant and prepare some propofol because that is usually his favoured sedative agent
Perform synchronised DC cardiversion without sedation

2. Question

The consultant attends and states that he wants to supervise you performing the sedation. A nurse will perform the cardioversion. You consider the risks of sedation in this particular lady.

Describe three features of this patient's presentation that may modify your sedation technique or choice of sedative agent.

3. Question

Many adverse events are common to several sedative agents. Which drug is most typically associated with the adverse effects described?

Select the relevant agent for each adverse effect.

Sort elements

Midazolam
Propofol
Ketamine

Increased sensitivity to dose with age resulting in increased depth of sedation

Profound hypotension

Tachycardia and hypertension resulting in increased myocardial oxygen demand

4. Question

You have decided to sedate this 80-year-old female with VT for DC cardioversion. Her pulse remains 200, BP 86/55 and her SaO₂ is 98% on high flow oxygen.

What sedative agent are you going to administer?

Describe the dose, route, method of administration and one reason why you are going to use this particular agent.