The first step is assessment of the patient for sedation in the emergency department. The history should identify any abnormalities of the major organ systems and airway; previous adverse experience with sedation, analgesia, or anesthesia; any neurologic disorder or impairment; medications and allergies; and time and nature of the patient's last oral intake. Focused physical examination should include baseline vital signs and oxygen saturation, evaluation of cardiorespiratory status and the oropharynx and airway.
Appropriate candidates for sedation protocols in the ED are healthy patients or patients with mild systemic disease ( Table 1.3.0-12.). Children with severe systemic disease (ASA III or IV); infants <3 months of age; premature infants <60 weeks postconceptual weeks of age; and children with underlying respiratory/airway disease, neurologic conditions, CNS injury, multiple trauma, or liver/kidney disease are at increased risk for sedation complications and require consultation with an anesthesiologist.
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