The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

THE RESPIRATORY CARE PRACTITIONER AND PROCEEDURAL SEDATION IN THE EMERGENCY ROOM SETTING

Robert Delong, Jhaymie Cappiello, J Brady Scott, Michael Gentile, Janice Thalman, Neil MacIntyre; Duke Medical Center, Durham, NC

BACKGROUND: Procedural sedation and analgesia (PSA) is a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function. PSA is intended to result in a depressed level of consciousness that allows the patient to maintain oxygenation and airway control independently. Existing literature does not provide clear evidence on the number of personnel necessary to safely provide PSA. The presence of support personnel with advanced airway skills assumes increased importance when the physician is involved in a procedure that precludes the ability to continually assess the patient’s clinical status. We sought to evaluate the safety and efficacy of utilizing a Respiratory Care Practitioner (RCP) providing airway monitoring and support during PSA in the emergency room setting. METHOD: After IRB approval, a retrospective chart review was performed over a 12 month period. Medications used included ketamine, versed, fentanyl, morphine, etomidate, and ativan. The three person team consisted of RN, RCP and MD. The RN documented procedure, monitored vital signs, and administered medications; The RCP monitored vital signs, ETCO2 via nasal prongs, airway patency and provided airway support as indicated; the MD ordered medications and performed the procedure. A Modified Ramsey Scale (MRS) was used to measure depth of sedation. Adverse events were identified as cyanosis, loss of airway, bradycardia, hypotension, aspiration, and the need for intubation. RESULT: During our study period, PSA was performed on 146 patients. The outcome of all of the procedures performed met physician’s satisfaction, 20 patients reached a MRS of 6 and only one of those required a brief period of bag-valve-mask ventilation. No other adverse events or outcomes were noted. Common indications for PSA were fracture reduction, laceration repair and cardio-version. No patient required intubation. The maximum ETCO2 was 66. The lowest level of oxygenation was SpO2 of 99%. CONCLUSION: Utilizing a Respiratory Care Practitioner (RCP) providing airway monitoring and support during PSA in the emergency room setting is safe and efficacious. More study is recommended to determine if primary airway personnel is required in this setting. Sponsored Research - None

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