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1)In your community hospital, are ELECTIVE CT/MRI's done, or are they
all sent into town?  Who administers the sedation?  Radiology?
Anesthesia?  In-house Pedi?
 
  I'm not sure what you mean by sent "in town".  Our community ED is
busy (68,000 per year) with 28% peds. All emergent CTs are done with
minimal/no sedation with spiral CTs.  The ED is responsible for any
sedation and strict monitoring is followed according to AAP standards.
 Can't speak for MRI since we don't have it- yet.
 
2)What are you doing about"certification/credentialing" to give
sedation? Must those who are PEM boarded also be credentialed?
 
Sedation is included as part of the credentialling process for all
EM/PEM trained personnel.  100% of charts are reviewed retospectively
to make sure all protocols and standards are being followed.
 
3) Can you use what you'd like for ED cases, or does anesthesia
dept.need to be called for deep sedation?
 
 We frequently end up in the area of deep sedation according to most
guidelines since we make frequent use of ketamine.  While this causes
some high sphincter tone for some individuals I feel it is safer than
using fentanyl/versed combos.  ED/PED physicians administer all
sedative agents in the ED. Currently looking at adding propofol to our
armamentarium.
 
 
Hope that helps.
 
Angelo Falcone, MD
Chairman, Dept of Emergency Medicine
Shady Grove Adventist Hospital
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