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ED - Procedural Sedation - Supplemental [5325]

ED - Procedural Sedation - Supplemental [5325] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Procedural Sedation - Supplemental [5325]
Procedural Sedation Preparation
Prescreen Documentation [153970]
Procedural Sedation Screening [NURMON0094] ONCE, Routine
Intended Sedation Level: Moderate
Intended Sedation Level: Moderate
Expected sedation start time:
Last PO intake (solid) Date: 9/13/2017
Last PO intake (solid) Time:
Last PO intake (clear liquid) Date: 9/13/2017
Last PO intake (clear liquid) Time:
Last PO intake (breast milk) Date: 9/13/2017
Last PO intake (breast milk) Time:
Problems with Anesthesia in the past?
Problems with Anesthesia in the past?
Family History of Anesthesia related problems?
History of snoring?
Teeth status:
Current URI?
Consent Obtained?
Neck Imobilized or Impaired Mobility:
Prepare for Procedural Sedation [153971]
Prepare for Procedural Sedation [NURCOM0022] ONCE, Procedure: {UWED SEDATION PROCEDURE
LIST:180182}
Prepare appropriately sized Bag/Valve/Mask
Device [NURCOM0022]
ONCE, • Set on 10-15 L oxygen
• Ensure 2 oxygen sources (one for BVM and other
for Oxygen via End Tidal-CO2 nasal cannula to give
as needed)
• For patients greater than 40 kg use adult 1 L bag,
and for patients less than 40 kg use pediatric 0.5 L
bag
Prepare Suction [NURCOM0022] ONCE
Bring Airway Cart to outside of room
[NURCOM0022]
ONCE
Prepare Normal Saline 20mL/kg IV with pump at
bedside (DO NOT GIVE) [NURCOM0022]
ONCE
Patient Care Orders [153916]
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
ETCO2 Monitoring [RT0006] CONTINUOUS, Routine
Respiratory [153972]
Cardio-Respiratory Monitor - Adult
[NURMON0061]
CONTINUOUS, Routine
Respiratory [153907]
Cardio-Respiratory Monitor - Pediatric - Without
Rhythm [139420]
Cardio-Respiratory Monitor - Pediatric - Without
Rhythm [NURMON0074]
CONTINUOUS, Routine, Please complete the Notify
Provider order below, including specification for
apnea > *** seconds. If indicated, order pulse
oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider:
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/13/2017 3:32:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds
Medications - PEDIATRIC
Pre-Sedation Medications [153908]
times)Consider to reduce risk of vomiting (particularly if shorter NPO Ondanestron:
secretions Consider if patient is less than 2 years old or if increased Atropine:
Consider if extremely anxiousMidazolam:
Consider adjunct for pain caused in deep sedationFentanyl:
ondansetron (ZOFRAN) injection - NOTE:
Maximum dose of 4 mg [800202]
0.15 mg/kg, Intravenous, ONCE For 1 Doses
NOTE: Maximum dose of 4 mg
atropine injection - NOTE: MINIMUM dose of 0.1
mg IV, MAXIMUM dose of 0.5 mg IV [800178]
0.01 mg/kg, Intravenous, ONCE For 1 Doses
NOTE: MINIMUM dose of 0.1 mg IV, MAXIMUM dose
of 0.5 mg IV
midazolam (VERSED) injection - NOTE:
Maximum 2 mg IV as adjunctive [800197]
0.05 mg/kg, Intravenous, ONCE For 1 Doses
NOTE: Maximum 2 mg IV as adjunctive
FENTanyl PF injection - NOTE: Suggested Dose
0.5-2 mcg/kg (MAXIMUM dose 100 mcg)
[800187]
1 mcg/kg, Intravenous, ONCE For 1 Doses
NOTE: Suggested Dose 0.5-2 mcg/kg (MAXIMUM
dose 100 mcg)
Intended MODERATE Sedation Medications [148762]
reduction) Anesthesia and analgesia properties (good for fracture Ketamine:
No analgesic properties. (If painful procedure, MUST combine with another Midazolam:
medication such as fentanyl)
Useful in Combination with MidazolamFentanyl:
Ketamine intraVENOUS - NOTE: Caution if
URI/increased secretions [203919]
ketAMINE intraVENOUS [800191] 1 mg/kg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
ketAMINE intraVENOUS [800191] 0.5 mg/kg, Intravenous, EVERY 5 MINUTES PRN,
Intended Sedation Level
Intended for procedural sedation
FENTanyl PF injection - NOTE: May cause
respiratory depression, rigid chest (young infants)
[800187]
0.5-2 mcg/kg, Intravenous, PRN, Sedation
Intended for procedural sedation
ketAMINE intraMUSCULAR - - NOTE: Caution if
URI/increased secretions) [800191]
4 mg/kg, Intramuscular, ONCE For 1 Doses
Intended for procedural sedation
midazolam (VERSED) injection - NOTE: May
cause hypotension [800197]
0.05-0.1 mg/kg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
Intended DEEP Sedation Medications [153901]
years old, Provider provide Pediatric Deep Sedation for children 1 years old to less than 13 To
Sedation.must be credentialed in Pediatric Deep
bradycardia. Watch for hypoventilation, airway obstruction, hypotension, Propofol:
Watch for myoclonus Etomidate:
etomidate (AMIDATE) injection [760100] 0.1-0.3 mg/kg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
for 1 Minutes
Propofol Injection [188469]
propofol (DIPRIVAN) 10 mg/mL IV BOLUS
[730017]
1-2 mg/kg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
propofol (DIPRIVAN) 10 mg/mL IV BOLUS
[730017]
1 mg/kg, Intravenous, PRN, Intended for procedural
sedation
Intended for procedural sedation
Medications - ADULT
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/13/2017 3:32:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Pre-Sedation Medications [153919]
times)Consider to reduce risk of vomiting (particularly if shorter NPO Ondansetron:
Consider if extremely anxiousMidazolam:
Consder adjunct for pain caused in deep sedation Fentanyl:
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE For 1 Doses
midazolam (VERSED) injection - NOTE -
Suggested dose 1-2 mg [800197]
Intravenous, ONCE For 1 Doses
FENTanyl PF injection - NOTE - Suggested dose
25-100 mcg [800187]
Intravenous, ONCE For 1 Doses
Intended MODERATE Sedation Medications [153898]
reduction) Anesthesia and analgesia properties (good for fracture Ketamine:
No analgesic properties (if painful procedure, MUST combine with another Midazolam:
medcation such as fentanyl)
Useful in Combination with MidazolamFentanyl:
Ketamine intraVENOUS - NOTE: Caution if
URI/increased secretions [188470]
ketAMINE intraVENOUS [800191] 1 mg/kg, Intravenous, ONCE For 1 Doses
ketAMINE intraVENOUS [800191] 0.5 mg/kg, Intravenous, PRN, Sedation
Midazolam Injection - NOTE: May Cause
Hypotension [188471]
midazolam (VERSED) injection [800197] 2 mg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
midazolam (VERSED) injection [800197] 0.5-2 mg, Intravenous, PRN, sedation, Intended for
procedural sedation
Administer every 2 minutes Intended for procedural
sedation
Fentanyl injection - NOTE: May cause respiratory
depression, rigid chest [203940]
FENTanyl PF injection [800187] 50 mcg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
FENTanyl PF injection [800187] 12.5-50 mcg, Intravenous, PRN, Intended for
procedural sedation
Administer every 2 minutes Intended for procedural
sedation
Intended DEEP Sedation Medications [153905]
bradycardia Watch for hypoventilation, airway obstruction, hypotension, Propofol:
Watch for myoclonus Etomidate:
etomidate (AMIDATE) injection [760100] 0.15 mg/kg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
for 1 Minutes
Propofol Injection [188473]
propofol (DIPRIVAN) 10 mg/mL IV BOLUS
[730017]
0.5-1 mg/kg, Intravenous, ONCE For 1 Doses
Intended for procedural sedation
propofol (DIPRIVAN) 10 mg/mL IV BOLUS
[730017]
0.25-1 mg/kg, Intravenous, PRN, Intended for
procedural sedation
Intended for procedural sedation
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/13/2017 3:32:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org