In response to the question about how long we are "tied up"
doing sedation with our protocol (a physician not involved
in the procedure giving sedation and monitoring the pt, and
a nurse as well, who can assist)... Fracture reductions
usually take 30-45 minutes. If the ED is too busy, we often
make ortho wait until the needed personnel are available-30
min or so, but give the patient some pain medication in the
meantime. After the procedure is complete, and the child
goes to xray for a post-reduction film is when we
relinquish control. As for other procedures: if plastics has
a quick case (30 min) and we have the personnel, we will
give conscious sedation.
We have 5-6 pulse oximeters in the ED (we have 23 beds).
Staffing wise, we have 30 hrs of attending/fellow coverage
in the ED per day, and a 3rd yr pediatric resident 11
One thing that we have found is that we have spoiled the
orthopods. If we are available, they assume that we
can provide sedation, therefore they have forgotten
how to give hematoma blocks and rarely go to the OR. (Don't
worry, we express our minds and sometimes refuse to assist
due to the severity, deformity and angulation of the
fracture). At the adult EDs they can give sedation and do
the procedure, but we don't feel their airway skills are
adequate and they tend to concentrate on the extremity, not
One other thing to note. You can bill for IV sedation in
the ED, and we do if an attending or fellow does it.
Susan Fuchs M.D.
Children's Hospital of Pittsburgh
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