Equipment and Monitoring

The ED must be appropriately equipped for administering sedation to children of all ages and sizes. An oxygen source capable of delivering >90 percent oxygen and positive pressure ventilation, appropriate size masks, and functioning suction apparatus with Yankauer-tip catheters must be at the child's bedside. Appropriately-sized laryngoscopes, endotracheal tubes, intravenous catheters, and emergency medications must be readily available. Airway management and breathing equipment must be checked before each sedation procedure.

The child should be attached to a cardiac monitor and pulse oximeter. During the procedure, one person whose sole responsibility is monitoring the patient, preferably a registered nurse with basic life support and PALS training, or a physician who is not performing the procedure, must be present. Continuous quantitative monitoring of oxygen saturation (pulse oximetry) and heart rate, and intermittent monitoring of respiratory rate and blood pressure should be recorded at 5- to 10-min intervals. Level of consciousness (response to verbal commands/tactile stimuli) and pulmonary ventilation (observing chest wall excursion and/or auscultation of breath sounds and/or capnography) should also be monitored. All drugs and doses administered must be clearly documented, with special attention to calculation of single and cumulative doses in mg/kg.

After the procedure, the child must be observed and monitored in an area with suitable equipment and vital signs recorded every 15 minutes. Pulse oximetry should be maintained until the patient is fully alert. Observation should be continued until all discharge criteria are met ( Table 130-13). Appropriate discharge instructions with follow-up should be conveyed to the child's caretaker.

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