Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Procedural Sedation Ed Safety, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CBC/BMP (Baseline labs), CXR/targeted imaging (Common ED complaints), Troponin/EKG (chest pain) (ACS rule-out). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Analgesics, Antiemetics. Use validated frameworks (e.g., Common Agent Considerations) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Epidemiology / Risk Factors
- Varies by presentation; age/comorbidities matter
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC/BMP | Baseline labs | Abnormalities | |
| CXR/targeted imaging | Common ED complaints | Findings vary | |
| Troponin/EKG (chest pain) | ACS rule-out | MI changes | Use risk tools |
Common Agent Considerations
| Agent | Pros | Cautions |
|---|---|---|
| Propofol | Rapid on off | Hypotension, apnea |
| Ketamine | Preserves airway reflexes, analgesia | Emergence reactions, emesis |
| Etomidate | Hemodynamic stability | Adrenal suppression with repeated dosing |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Ketamine | NMDA antagonism | Minutes | Dissociative sedation; preserves airway reflexes | Emergence reactions; ED use |
| Propofol | GABA-A agonism | Minutes | Deep sedation; rapid offset | Hypotension; ED use |
| Fentanyl + midazolam | μ-agonist + GABA-A | Minutes | Analgesia + anxiolysis | Respiratory depression; ED use |
Prognosis / Complications
- Outcomes tied to emergency and timeliness of care
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Assign roles for airway, medications, and procedure. Document vitals and events at frequent intervals.