Procedural sedation in the emergency department

Procedural sedation and analgesia is intended to result safely in a depressed level of consciousness that allows the patient to maintain oxygenation and airway control independently during painful procedures.

Suggested use in short but painful procedures:

• Reduction of fractures/dislocations
• Incision and drainage of abscess
• Foreign body removal
• Electrical cardioversion
• Suturing in children

Individual response to sedating agents is variable. Procedural sedation potentially carries all the risks of anaesthesia despite, the vast majority of the time, being considerably safer. Because of this all institutions should have policies and guidelines for different levels of clinicians providing different levels of sedation. 

The purpose of this package is to guide Emergency Departments towards a reproducible policy ensuring safety and appropriate use of medications. It does not include the scope of Rapid Sequence Induction. The package provides a suggested policy, levels of sedation, a procedural sedation record template, a brief overview of medications, a guide on accreditation of ED clinicians and a reference for essential background reading.

• ED Sedation Procedure

• Levels of sedation

• Brief overview of medications

• Procedural Sedation Accreditation

• Further references and resources

• ACI Safe Sedation Resources

• E-Learning Resources

Paediatric Procedural Sedation

• Ketamine Use in ED - Sydney Children's Hospital Drug Protocol

• Procedural Sedation Patient Factsheet - Royal Children's Hospital, Melbourne

Relevant Patient Factsheets

• Procedural sedation - Adult (developed by the ECI)