L3 Sedation Standards Flashcards
Ramsey Scale for Sedation
- Pt anxious and agitated or restless or both
- Pt cooperative and tranquil but oriented
- Pt responds to voice commands only
- Pt exhibits response to light tap on forehead or
load auditory stimuli. - Pt has sluggish response to tap/noise.
- Pt exhibits no response.
ASA Classification
- Normal healthy Patient
- Mild systemic disease, well controlled
- Severe systemic disease, controlled
- Severe systemic disease with a constant
threat to life. - A pt. Not expected to live without the
operation. - A pt. Not expected to live 24 hours.
Expected drugs for clinic
- Oxygen
- Epi
- Antihistamine
- Nitro-glycerin
- Bronchodilators
- ASA
- Oral glucose
Expected standard equipment
- Pocket masks
- Reservoir mask
- 1-3 ml syringes with 23 gauge 1.5 inch needle
- Sphyngomanometer
- Stethoscope
- Ambubag
- Oral pharyngeal suction devise - tonsil suction
Where and when do you report adverse reactions to sedatives
Reported to the association
- any adverse reaction or incident
- any use of basic or advanced life support
Reported within 15 days
Special form for member use
Section 1 - Anxiolysis
ASA I or II
Pt drops below Ramsey level 2 - stop procedure, discharge when returned to level 2
Section 2 - Conscious Sedation
ASA I or II
Pt drops below Ramsey level 3 - stop procedure, discharge when returned to level 2
Section 2 - Oral sedation
ASA I or II adults 12+, children 5-12 = apply to MDA with 5 cases practice and 6 hour course
kids need extra courses and 5 supervised cases of children
ASA III - apply to MDA for pt over 12, have completed a GPR performed 5 supervised cases of oral sedation for adults ASA III
Where do you have to record your oral sedation use?
- in the patients chart
2. in a separate log of drug use that is available to the registrar
How often do you have to be certified for oral sedation?
Every 5 years
a. recognized 6 hour course
b. 5 cases in practice per year
c. perform 5 cases of ASA III or children 5-12 per year
Section 3 - conscious sedation, nitrous
Facility has to be certified by MDA every 5 years
a. need scavenging equipment
b. 5 cases per year and a 6 hour update course
c. children under 5 - ASA I and II only
*separate category for ASA III
Section 4 - IV and IM sedation
Ramsey level 4 max
Facility certified every 5 years
At least 5 cases per year, 6 hours of course study, and 3 hours of study group
ASA I and II
Significant documentation needed w/ extra training
Continued competence
What additional emergency drugs do you need for IV/IM sedation?
- Parenteral vasopresser
- Flumazenil
- Naloxone
- IV fluids
Oral and parenteral dextrose
Parenteral corticosteroid, parenteral atropine
What do you need to become a new IM/IV registrant?
20 hours didactic
20 supervised cases
Children under 12 - sedation must be done by anaesthetist
Section 5 - multiple modalities
Register with MDA to perform
Ambulatory ASA I, II or III
