RoshQuiz Answer 1.2

Question: In patients undergoing procedural sedation and analgesia in the emergency department, what is the minimum number of personnel necessary to manage complications?

A. Only the physician performing the procedure

B. The physician performing the procedure, a physician performing the procedural sedation, and a nurse

C. The physician performing the procedure and a nurse

D. The physician performing the procedure and two nurses

Answer C

Explanation: According to Godwin et al., during procedural sedation and analgesia, a nurse or other qualified individual should be present for continuous monitoring of the patient, in addition to the provider performing the procedure. Physicians who are working or consulting in the ED should coordinate procedures requiring procedural sedation and analgesia with the ED staff. Therefore, a trained provider performing the procedure should be present at all times, as well as a nurse or other qualified individual for the continuous monitoring of the patient is a “Level C” recommendation. “Qualified individual” should be a clinician capable of detecting events such as hypotension, hypoventilation, hypoxia, and dysrhythmias. The clinician supervising the procedural sedation must be able to: (1) choose appropriate pharmacologic agents; (2) monitor patients to detect complications such as hypotension, hypoventilation, hypoxia, or dysrhythmias; and (3) manage the potential complications. Two Class III studies reported data demonstrating a similar rate of complications whether a single physician or 2 physicians were present for the procedural sedation alongside a nurse monitoring the patient. However, the staffing decisions were not randomized or determined a priori. Further studies of staffing necessary for procedural sedation should control for the type of medication and dosing administered, the type of procedure performed, the type of medical personnel present, patient comorbidities, and current clinical condition.

According to Godwin et al., there needs to be more than just the physician performing the procedure (A). For complex or difficult sedations, the physician in charge may elect to have a physician performing the procedure, a physician performing the procedural sedation, and a nurse (B) or the physician performing the procedure and two nurses (D). The discretion is up to the physician in charge.

Article: Godwin SA, Burton JH, American College of Emergency Physicians, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014;63(2):247-258.

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