Staff, Equipment and Environment

Procedural Sedation in Emergency Medicine 2024 Safe Practice Staff, Equipment and Environment

**Table 5 Requirements for Adult Procedural Sedation**³

Whilst the use of Entonox and opioids is generally safe throughout the ED, you should ensure procedural sedation takes place in either the resuscitation room or another area with advance life support equipment. Such facilities are outlined in table 6.

Table 6: Equipment and Drugs Required for Safe Sedation³

Full resuscitation equipment for the administration of basic and advanced life support (including airway adjuncts, and equipment for intubation ETT, laryngoscope, bougie etc.). Equipment should be checked daily, and after each use. Auditable record of checks should be kept.
Continuous high flow oxygen and appropriate devices for administration (e.g. non- rebreathe oxygen masks, bag-valve-mask)
High pressure suction and appropriate suction catheters
Trolley capable of being tipped head down
Monitoring: pulse oximetery, ECG, NIBP, continuous quantitative capnography
Appropriate range of intravenous cannulae
Appropriate range of intravenous fluid and infusion devices
Difficult airway equipment
Manual handling devices
Clock / event timer
Ability to summon help immediately if required

Adrenaline
Atropine
Dextrose 10% or 20%
Amiodarone
Naloxone
Flumazenil
Drugs for emergency intubation

The use of oxygen during procedural sedation is encouraged especially for at risk patient groups (e.g., ischaemic heart disease) and those undergoing deep sedation procedures (increased risk of short periods of apnoea).³ Monitoring during procedural sedation should include: 3 lead ECG, oxygen saturations, continuous capnography, non-invasive blood pressure³ as a standard of care. Patient vital signs should be recorded before, during and after the procedure every five minutes is probably practical. Observations should be recorded on a chart. Perform a timeout before starting the procedure: a checklist of right patient, right side, monitoring, equipment, personnel, plan A, plan B, etc.

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