Susan Fuchs and Thomas Terndrup have described their sedation environments. I
would say that down here in NYC at Bellevue Hospital, its pretty much the same.
Most of the procedures are either ortho manipulations, or fingertip repairs.
In general the ED staff is responsible for administereing and monitoring
sedation while the procedure is being performed. Either pediatric or emergency
medicine residents are performing sedation under the guidance of an attending.
If one of the ED residents is doing a procedure, I will do the sedation.
Although it seems appropriate and perhaps standard care to have a nurse at the
bedside for the entire procedure, we find it very hard to keep a nurse at the
bedside for morte than a short while. We are hoping that a new QI project
about monitoring during sedation which requires frequent documentation of vital
signs a ala AAP recommendations will change things a bit.
Pediatric Emergency Service