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          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
          hrs/day.
 
          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
          the patient.
 
          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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