A number of agencies have published sedation best practice guidelines [1-3]. With the exception of the NAEMSP statement on drug-assisted airway management, none of these are prehospital specific [4].
Adverse events have been reported in 10% of the prehospital population receiving sedation (most commonly hypoxia). Severe adverse events are relatively rare (2%) but may include severe hypoxia and cardiac arrest [5]. A consistent approach is important to achieve the best results for the patient in the safest manner possible, especially considering the uncontrolled environments faced in prehospital care. My approach incorporates components from each set of guidelines.
Evaluate the patient
The patient’s specific needs will determine the ideal level of sedation required.
Scared to fly? Anxiolysis.
Need cardioversion? Conscious sedation.
Trouble with the ventilator? Deep sedation.
Rapid sequence intubation (RSI)? General anesthesia.
Is pain a factor? Typically, patients do better if pain is controlled first and sedation is added after. This concept, referred to as anglo-sedation, is based on experience in the ICU [6].
The …