CONSCIOUS  SEDATION

1. Conscious sedation is done in the ER in order to decrease patient awareness of pain during a painful procedure. Ensure you  monitor patient's VS and  avoid compromising patient's airway.
    
2. Obtain consent.
    
3. Place IV and NS drip prn - patient may experience transient drop in BP.
    
4. Prepare pulseOx and give 6L of O2 via NC. Place automatic BP cuff.
    
5. Have antagonists such as Flumazenil and Naloxone at bedside "just in case".
    
6. Administer Midazolam 1mg and repeat after 1 min prn to a max of 0.1 mg/kg (7-8 mg in adults) Midazolam's action is about ½ - 2 hrs. It provides sedation and anxiolysis. Other  sedatives  can also be used.
    
7. Administer  opiate for analgesia. Fentanyl is generally  used  given its short duration of 30 min (vs. MSO4 that has duration of 4-6 hrs.). The dosage of Fentanyl is 1 mcg/kg.  Other analgesics can also be used.
    
8. Do not simply reverse and walk away from patient once the procedure is completed. The antagonist may have a shorter action duration  than the opiates and the patient may re-collapse back into the anesthetic's sedative effect. 

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