Sedation performed by ER nurses.

[chbare]

This is a really hot topic in the emergency nursing world. Thought I would throw it out for discussion. Should non-anesthesia providers be providing conscious sedation? In addition, should RN's be able to push agents capable of producing induction. Diprivan and etomidate for example?

If so, is additional education required? What about airway management education? Does an ACLS course provide adequate airway management education? Where do we draw the line? Is a national standard required or should it be left to the states and facilities. Should a national standard educational program be required, or an in house program?

Take care,
chbare.

[Ridryder 911]

From what I have seen and read it is a promotion of CRNA's to "ensure' that only those know sedation techniques... yadda, yadda whatever.. the same issue some CRNA'a in various states only want CRNA to be able to establish EJ IV's.. $$$$

It was an issue in my state until ENA, AACN, ACEP became involved. Only physicians were able to administer in ICU/CCU/ ED's while preparing to intubate, etc.. too much for a "controlled setting".. as well as Flight Nurses, etc could no longer RSI.. The State Board immediately changed that qualified nurses (must have additional sedative education, as described by JCAHO, etc) can assist in administering sedation under the direct order of a physician or proven documentation of approved education as in ASTNA.

R/r 911

[SEMTA1]

In Arizona, as far as I know (I'm not a nurse) but as it was explained to me, flight RN's can do sedation (for what they carry, Vecuronium, Succ, Etomidate, Versed). However, DHS DOES allow it, but it's a very specific circumstance. The MD's hands must physically be full and s/he physically can't push them. However, this is for initial sedation ONLY. RN's can push seditives to KEEP them under.

[supermedic]

I also view this entire issue as little more than a play by CRNA's to protect their turf.

Conscious sedation is only done (or should only be done) in the immediate presence of a physician....presumably a physician who has the tools and skills to secure an airway should the need arise. For that reason, requiring the presence of an anesthesia provider when etomidate or propofol is used is really ridiculous.

RSI is an entirely different scenario. In RSI the very inention is to cause apnea and by definition someone is immediately prepared to secure the airway. Conscious sedation is much trickier because you are trying to maintain adequate breathing and airway reflexes while inducing a fairly deep level of sedation. I'd say some additional education is prudent, but no more than is required to teach competence in many critical care nursing skills.

As long as the patient is properly monitored and someone is immediately present who can secure the airway if need be, I see no reason why a trained RN can't safely provide conscious sedation. In this controlled setting propofol and etomidate are no more dangerous than many other drugs routinely given by RN's.

ACLS does not even come close to providing the skills and experience needed to properly manage an airway, and I don't think intubation is an appropriate or necessary skill for most RN's to practice.

[Dami2000]

Is the H1N1 Flu very dangerous???

[PKpangZer]

As continued as the accommodating is appropriately monitored and anyone is anon present who can defended the airway if charge be, I see no acumen why a accomplished RN can't cautiously accommodate acquainted sedation.



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Medical travel insurance

[Flores]

what the duce