Paeds Cases · clinical-pharmacology-and-therapeutics
Explaining procedural sedation, fasting and risk to a family — communication OSCE
Communication OSCE on explaining procedural sedation medicines to a family before a painful fracture reduction: the agent, the fasting decision, the monitoring, and the realistic risks and recovery.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A 5-year-old, 18 kg, has a displaced distal forearm fracture needing reduction. The plan is dissociative sedation with ketamine. The parents are anxious about sedation, have heard that fasting is needed before any anaesthetic, and ask what the medicine does, whether their child having eaten an hour ago is dangerous, what monitoring will be in place, and what to expect afterwards.
Station brief (8–10 minutes)
You have two linked tasks. First, explain to the parents in plain language what ketamine sedation involves, address their worry about the recent food, describe the monitoring, and prepare them for recovery. Second, outline to the examiner how the evidence on fasting and on monitoring shaped your reassurance. Use honest, specific language, acknowledge the real but rare risks, and confirm understanding with teach-back. Do not invent jurisdiction-specific statutory thresholds. [1]
References3ShowHide
- [1]Green SM, Tsze DS, Roback MG Emergency Department Ketamine Sedation: Frequency and Predictors of Critical and High-Risk Adverse Events Ann Emerg Med, 2025.PMID 40481829
- [2]Bhatt M, Johnson DW, Taljaard M, Chan J, Barrowman N, Farion KJ Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children JAMA Pediatr, 2018.PMID 29800944
- [3]Langhan ML, Chen L, Marshall C, Santucci KA Detection of hypoventilation by capnography and its association with hypoxia in children undergoing sedation with ketamine Pediatr Emerg Care, 2011.PMID 21494162