SPS SOCIETY FOR PEDIATRIC SEDATION safe and sund SOCIETY FOR PEDIATRIC SEDATION 2209 Dickens Rd., Richmnd, VA 23230-2005 (804) 565-6354 Fax: (804) 282-0090 www.pedsedatin.rg 1. SKILLS A. Pre-Sedatin Physical Assessment (fcus n neurlgical, cardiac, respiratry, airway) Vital Signs IV Access Labratry Tests/Values Medicatin Preparatin B. Intra-Sedatin Medicatin Administratin Bag-Valve-Mask Ventilatin Suctining Psitining Mnitring Airway Adjuncts C. Pst-Sedatin Psitining Airway Management Vital Signs IV Access Falls Preventin 2. KNOWLEDGE A. Pre-Sedatin Screening/Histry/Patient Cnsideratins Prcedural Cnsideratins Family Educatin Sedatin Medicatins
Rm Preparatin Patient Preparatin B. Intra-Sedatin Recgnizing When t Intervene Mnitring & Dcumenting Patient Respnse Adjusting the Sedatin Plan C. Pst-Sedatin Cntinue Airway Management Knw the Effects f the Medicatins Wrk Tward Transfer/Discharge Readiness Family Educatin Fllw Up SKILLS A. Pre-Sedatin Physical Assessment Obvius Develpmental Delays r Physical Defrmities Neurlgical Status Level f Cnsciusness Hypertnia/hyptnia Develpmental Delay Palsy/Cranial Nerve Issues Respiratry Status Wrk f Breathing/respiratry effrt (grunting, retractins, muth breathing) Obvius upper respiratry infectin symptms (runny nse, cugh, audible wheeze) Breath sunds (clear, carse, wheeze, diminished) Severe sclisis
Cardivascular Status Arrythmias Murmurs Capillary Refill Pulses Airway Status Malampati (http://www.drpaulse.cm/wp-cntent/uplads/mallampati.jpg) Small/retracted mandible Inability t pen muth wide Large tngue/ flppy airway Neck mass/swelling Tnsillar size Vital signs (Grwth & Develpment cnsideratins: equipment & values apprpriate fr age) Nrmal values Tachycardia/bradycardia Tachypnea/bradypnea Hypertensin/hyptensin Oxygen saturatin Temperature IV Access (Grwth & Develpment cnsideratins: age apprpriate distractin, explanatin, IV site) Peripheral r central line access Pre-medicatin (versed, elamax, emla) Anatmical Lcatin Vascular integrity Psitining/immbilizing Labratry Tests/Values (Grwth & Develpment: apprach/technique, address pain/ fear) Pregnancy Screening Hemglbin and Hematcrit Bld Cunts fr Hematlgy/Onclgy
Medicatin Preparatin 5 Rights (patient, medicatin, dse, rute, time) Blus dsing Cncentratin Dilutin/Diluents Prgramming Drips Checks & Balances/Time Out Patient Specific Cde Sheet B. Intra-Sedatin (rutine and emergent skills) Medicatin Administratin Rate f administratin Bag-Valve-Mask Ventilatin (Grwth & Develpment cnsideratins: apprpriate sized supplies fr age/size) Self-inflating r anesthesia/maplesn bag Apprpriate size mask (gd seal) Oxygen surce/flw Airway psitin prmtes adequate ventilatin (chest rise) Adequate ventilatry rate Other cnsideratins (trach, c-spine instability) Suctining (Grwth & Develpment cnsideratins: apprpriate sized supplies fr age/ size) Remval Naspharyngeal/Orpharyngeal secretins Vmiting/preventing aspiratin Psitining (Grwth & Develpment cnsideratins: physical size and anatmical cnsideratins) Airway psitin Circulatry cnsideratins Safety (seat belts, padding, MRI/radiatin precautins, sterile field)
Mnitring (Grwth & Develpment cnsideratins: apprpriate sized supplies/equipment/default settings n mnitrs) Pulse ximeter prbe placement/accurate reading Bld pressure cuff size and lcatin Reading end tidal carbn dixide tracing Temperature mnitring n nenates Airway Adjuncts (Grwth & Develpment cnsideratins: apprpriate sized supplies) Blw by/nasal cannula xygen Naspharyngeal/Orpharyngeal tube size determinatin and prper placement Laryngeal Mask Airway/Endtracheal tube size and placement C. Pst-Sedatin Psitining Neck/Shulder Rll Side Lying Pst Prcedure Requirements Airway Management Remving airway adjuncts Oxygen administratin Caregiver Hlding Vital Signs Stable versus Unstable IV access Maintain versus Discntinue CVL, prtacath and PICC prcedures Falls Preventin (Grwth & Develpment cnsideratins: independence versus safety) Side rails/seat Belts Wheelchair
KNOWLEDGE A. Pre-Sedatin Screening/Histry/Patient Cnsideratins Reasn fr prcedure/sedatin Prir issues with sedatin r general anesthesia Paradxical reactins Allergic reactins Family histry f Malignant Hyperthermia Emergence Reactins Ptential airway issues Apnea Asthma/Reactive airway disease/upper respiratry infectin Obesity Tnsillar/adenid hypertrphy Syndrmes (Dwns, Pierre Rbin, Marfans, Mucplysaccharidses) Trachemalacia/Laryngmalacia Prir trachestmy Vascular ring Cerebral Palsy/ther cnditins f muscle weakness Severe sclisis Swallwing prblems Severe Reflux Ptential cardiac issues Pulmnary hypertensin Acute Cardimypathy/Ejectin Fractin <35% Hypplastic Left Heart Single Ventricle physilgy must be past Fntan William Syndrme with cardiac ischemia
Baseline neurlgical/develpmental status Within nrmal limits versus develpmental delay Age/maturity level warrants trying withut sedatin Thermregulatin Cnsideratins Disrders f the fllwing systems Endcrine Hepatic Metablic Renal Bld Drug r Fd Allergies Current Medicatins NPO status Last menstrual perid Weight/Height Pertinent labratry values Prcedural Cnsideratins Lcatin/Envirnment Painful versus Nn-painful Length f Prcedure Radiatin Precautins Magnetic Field Precautins Sterile field Requirements Additinal Cnsents Lab wrk Requirements IV Access Requirement Special Psitining Temperature Cnsideratins
Family Educatin Infrmatin/explanatins tailred t develpmental level f patient and family Prcedure Sedatin Plan Pst Sedatin Expectatins Sedatin Medicatins Tailred t patient/prcedure t be cmpleted Cntraindicatins Side effects Apprpriate/maximum dsing Rute ptins Onset f actin/duratin f effects Reversal Agents Rm Preparatin Functining Equipment Mnitr Bag-Valve-Mask Oxygen Suctin Medicatin Pump Team Prepared Patient Preparatin Functining IV Patient/Family Questins Addressed Prcedural Screenings Cmpleted Time Out Perfrmed (checklist) Tw patient identifiers reviewed Weight Allergies Medicatin Dses Prcedure t be Dne
Immediate Pre-Prcedure Vital Signs B. Intra-Sedatin Recgnizing When t Intervene Apnea/Hypventilatin Upper Airway Obstructin/Laryngspasm Cardivascular Instability Pain Medicatin Reactins Mnitring & Dcumenting Patient Respnse Amunt f Medicatin Required Additinal Medicatins Required Any Airway Management Interventins Required Adverse r Unexpected Events Vital Signs Every 5 Minutes Includes Level f cnsciusness Includes Pain Rating Abnrmal Vital Sign Causes Check the PATIENT First Medicatin Equipment Pain Adjusting the Sedatin Plan Based n the Patient s Respnse Based n the Gal f the Prcedure C. Pst-Sedatin Cntinue Airway Management Vital Signs Wrk f breathing/respiratry effrt Airway Adjuncts in Place/Remved
Knw the Effects f the Medicatins Side Effects Hw Lng Effects Last Decrease External Stimulatin Wrk Tward Discharge/Transfer Readiness(Grwth & Develpment cnsideratins: tddlers asserting cntrl by refusing t eat/ drink) Return t baseline vital signs and level f cnsciusness Scring Tl (Aldrete r ther) Tlerating slids/liquids by muth Transfer t Lwer Level f Mnitring Family Educatin Medicatin Specific Ptential Airway Prblems Risk f Falls Diet and Hme Medicatins Fllw Up/Quality Reprting Prblems Identifying Trends