Perform procedural sedation for a fracture reduction — OSCE

OSCE procedural station: assess a 5-year-old before procedural sedation for an urgent forearm fracture reduction, perform the pre-sedation safety check, choose and dose the agent, set up the monitoring and rescue equipment, and outline the management of deterioration and the recovery and discharge criteria.

Prompt

A 5-year-old, previously well (ASA I), is brought to the emergency department after a fall with a displaced forearm fracture that requires urgent reduction. He last ate a light meal three hours ago. He is distressed and in pain. The team has decided on procedural sedation. You are the paediatric registrar asked to perform the pre-sedation assessment, set up for safe sedation, choose and dose the agent, and outline the conduct, monitoring, management of complications, and recovery and discharge.

Candidate brief

You have this station to assess a 5-year-old before procedural sedation for an urgent forearm fracture reduction, perform the structured pre-sedation safety check, choose and dose the agent, set up the monitoring and rescue equipment, outline the conduct and the management of a deterioration, and discuss the recovery and discharge criteria. Treat this as a time-critical but controlled procedure in a child who meets the criteria for sedation by a trained team. ^[1] ^[2]

References4Show

[1]Coté CJ, Wilson S Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures Pediatrics, 2019.PMID 31439084
[2]Green SM, Roback MG, Kennedy RM, et al Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update Annals of Emergency Medicine, 2011.PMID 21256625
[3]Langhan ML, Shabanova V, Li FY, et al A randomized controlled trial of capnography during sedation in a pediatric emergency setting American Journal of Emergency Medicine, 2015.PMID 25445871
[4]Green SM, Krauss B Pulmonary aspiration risk during emergency department procedural sedation--an examination of the role of fasting and sedation depth Academic Emergency Medicine, 2002.PMID 11772667

Perform procedural sedation for a fracture reduction — OSCE

Candidate brief

References4Show

[1]Coté CJ, Wilson S Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures Pediatrics, 2019.PMID 31439084
[2]Green SM, Roback MG, Kennedy RM, et al Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update Annals of Emergency Medicine, 2011.PMID 21256625
[3]Langhan ML, Shabanova V, Li FY, et al A randomized controlled trial of capnography during sedation in a pediatric emergency setting American Journal of Emergency Medicine, 2015.PMID 25445871
[4]Green SM, Krauss B Pulmonary aspiration risk during emergency department procedural sedation--an examination of the role of fasting and sedation depth Academic Emergency Medicine, 2002.PMID 11772667