Procedures //

PROCEDURE NOTE: Procedural sedation Indication: [ ] A formal consent is obtained from the patient after review the risks and benefits is performed. The patient signs the permission. The patient is kept in the supine position. An oral airway assessment is performed before any sedation is administered: Mallampati is [] Class I - complete visualization of the soft palate Class II - complete visualization of the uvula Class III - visualization of only the base of the uvula Class IV - soft palate is not visible at all ASA category [] ASA I A normal healthy patient Healthy, non-smoking, no or minimal alcohol use ASA II A patient with mild systemic disease Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease ASA III A patient with severe systemic disease Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents. ASA IV A patient with severe systemic disease that is a constant threat to life Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis ASA V A moribund patient who is not expected to survive without the operation Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction The patient was re-examined prior to start of sedation and is still an appropriate candidate for sedation, regardless of any prior medications given, if any. Continuous cardiac monitoring is also performed. A respiratory therapist as well as an emergency department nurse are in the room. A crash cart is also placed just outside of the room. The patient is administered [propofol] until adequate level of sedation his reach. End tidal CO2 monitoring is also performed throughout the entire procedure. After the intended procedure is completed, the patient is allowed to recover. The patient is subsequently assessed and is now awake and neurologically intact. There are no cardiac dysrhythmias, hypoxemia, or hypotension. No complications are encountered. Total face-to-face time is [ ] minutes.



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