Healthcare and Medicine Reference
In-Depth Information
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Administer supplemental oxygen to the patient. Nasal cannulae
Handy hints/troubleshooting
with a fl ow rate of 2-4 L/min are suitable, but will only provide
inspired oxygen levels of 24-35%.
Attach monitoring (minimum: continual pulse oximetry).
A high standard of monitoring is essential - continuous heart
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rate and oxygen saturations, and intermittent non-invasive blood
pressure are recommended.
Never underestimate the potential dangers of sedation - always
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Administer an increment of sedation according to the guide-
lines above. Typically this will be 2-4 mL of the agent.
Assess for response after 2-3 minutes. The patient should be
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have a back-up plan.
Be aware of respiratory or cardiac depression once a painful
comfortable and able to talk, but calm and slightly obtunded.
If the patient remains anxious or is wide awake, consider a fur-
ther dose of ¼ to ½ the original bolus. Reassess and repeat again
if necessary.
Monitor continuously by verbal communication, clinical signs
stimulus has been removed: this may be apparent after successful
joint reduction.
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Further reading
British National Formulary
Rosenberg PH. (2000) Local and Regional Anaesthesia , Wiley-Blackwell,
Oxford.
UK Academy of Medical Royal Colleges and Their Faculties. (2001)
Implementing and Ensuring Safe Sedation Practice for Healthcare Procedures
in Adults . www.rcoa.ac.uk/docs/safesedationpractice.pdf
Watts J. (2008) Safe Sedation for all Practitioners: A Practical Guide . Radcliffe
Publishing, Oxford.
Whitwam JG, McCloy RF, eds. (1998) Principles and Practice of Safe Sedation ,
2nd edn. Blackwell Science, Oxford.
and pulse oximetry (minimum).
Follow emergency protocols should the patient's airway be
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compromised or should they become unconscious.
If the patient becomes agitated or distressed during the proce-
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dure, give a further dose of ¼ to ½ the original bolus. Reassess
and repeat again if necessary.
Discontinue continuous monitoring only once the patient is
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fully awake and all observations are satisfactory.
Document the agent(s) used and any complications, and ensure
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that the observations are recorded accurately.
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