Book contents
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- 23 Patient Assessment and Preprocedure Considerations
- 24 Monitoring for Procedural Sedation
- 25 Pharmacology of Commonly Utilized Sedative Agents
- 26 Procedural Sedation for Pediatric Laceration Repair
- 27 Procedural Sedation for Pediatric Radiographic Imaging Studies
- 28 Procedural Sedation for Brief Pediatric Procedures: Foreign Body Removal, Lumbar Puncture, Bone Marrow Aspiration, Central Venous Catheter Placement
- 29 Procedural Sedation for Adult and Pediatric Orthopedic Fracture and Joint Reduction
- 30 Procedural Sedation for Electrical Cardioversion
- 31 Procedural Sedation for Brief Surgical Procedures: Abscess Incision and Debridement, Tube Thoracostomy, Nasogastric Tube Placement
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
29 - Procedural Sedation for Adult and Pediatric Orthopedic Fracture and Joint Reduction
from SECTION THREE - PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
Published online by Cambridge University Press: 03 December 2009
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- 23 Patient Assessment and Preprocedure Considerations
- 24 Monitoring for Procedural Sedation
- 25 Pharmacology of Commonly Utilized Sedative Agents
- 26 Procedural Sedation for Pediatric Laceration Repair
- 27 Procedural Sedation for Pediatric Radiographic Imaging Studies
- 28 Procedural Sedation for Brief Pediatric Procedures: Foreign Body Removal, Lumbar Puncture, Bone Marrow Aspiration, Central Venous Catheter Placement
- 29 Procedural Sedation for Adult and Pediatric Orthopedic Fracture and Joint Reduction
- 30 Procedural Sedation for Electrical Cardioversion
- 31 Procedural Sedation for Brief Surgical Procedures: Abscess Incision and Debridement, Tube Thoracostomy, Nasogastric Tube Placement
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
Summary
SCOPE OF THE PROBLEM
The closed reduction of fractures and dislocations presents an excellent situation in which to perform procedural sedation. Fracture and joint reductions involve a great deal more pain than the patient feels prior to or after the reduction. Procedural sedation should provide analgesia prior to and during the procedure, sedation, muscle relaxation, and procedural amnesia for these painful events. Proper sedation for these procedures has the additional benefit to the medical care provider(s) by optimizing patient relaxation to facilitate a successful reduction.
Once a reduction has been completed, patients often have less pain than prior to the procedure owing to stabilization of the bone or joint. The use of long-acting sedative agents for procedural sedation, in combination with long-acting analgesics, may lead to patients who have unnecessarily extended periods of sedation particularly following the procedure when stimulus and pain are minimal. Such an extended period may lead to respiratory depression at a time when patient monitoring has been reduced. This concern, in addition to caregiver desires to shorten procedural sedation times in order to reduce the period of moderate or deep sedation and the duration of extensive staff patient monitoring, has led to significant changes in medical practice in favor of short-acting sedation agents.
CLINICAL ASSESSMENT
Both the urgency of the patient's requirement for fracture or joint reduction and the patient's current and preexisting medical conditions must be considered prior to procedural sedation.
- Type
- Chapter
- Information
- Emergency Sedation and Pain Management , pp. 185 - 189Publisher: Cambridge University PressPrint publication year: 2008