This presentation goes through the topic of Procedural sedation and Analgesia in adults in Emergency department. It covers the ASA classes, medications used and complications of Procedural sedation in ED.

1. Procedural Sedation and
Analgesia in Adults in
Emergency Department
- Dr Varun Patel

3. When do we use it?

4. Cases -

7. Levels of Sedation?

17. ASA Class IV and above should be taken to OT. ASA Class I and II can be managed in
ASA Class III is a Judicious call to take.

19. ASA Class?
A 30-year-old woman is scheduled to undergo elective
surgery for removal of a large ovarian cyst.
Comorbidities include anemia from menorrhagia and
type II diabetes treated with metformin. She is a non-
smoker, occasional social drinker, and has a BMI of 42.

20. She will ASA Class 3

21. ASA Class?
A 70-year-old woman is scheduled to undergo an
emergency laparoscopic appendectomy. Comorbidities
include severe COPD as a consequence of a life-long
smoking habit, morbid obesity (BMI 46) and type II
diabetes. She gets short of breath walking more than a
few meters.

22. She will be ASA class IV

23. ASA Class?
A 25-year-old man sustained a severe head injury in a
motorcycle accident. He was not wearing a helmet.
After a neurosurgical decompression procedure and
numerous other interventions in the intensive care unit,
it is clear that there is no hope for recovery. He is
unresponsive to all noxious stimulation. Testing for
brain death is carried out according to the American
Academy of Neurology guidelines for Brain Death
Determination reveals a complete absence of central
nervous system function, and his family agrees to
make his organs available for transplantation.

24. He will be ASA Class VI

25. Medications used for
Sedation

28. Which drug to use in which
case?

34. A Study: Coaching patients about their dreams before giving IV Ketamine reduced
Occurrence of Emergence phenomenon almost to 0%

35. Your state of mind effects the chances of Emergence phenomenon occurence

36. If you see Trump nightmares, you feel like becoming Ted Bund

37. Case:
A 60yr old male with Unstable Ventricular Tachycardia with HR of 220
bpm, k/c/o- IHD. No other comorbidities

38. One important side effect – Adrenocortical Suppression, Hence CI in Sep

39. How does Etomidate cause
Adrenocortical
Insufficiency?
(Bonus Chocolate
question)

41. Case:
A 22yr old male patient who fell while cycling on a rough terrain,
Has suffered a posterior dislocation of left elbow joint. No Comorbidties

42. Propofol is a go to drug for all Short Orthopedic Procedures in previously healthy pa

47. Complications of Sedation

49. LARSON’S MANEUVRE

58. ACEP clinical policy