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SAQ 7

SAQ 7. Write a protocol for the use of ketamine for procedural sedation in the emergency department (100%). Question. Core knowledge Wide range of level of answers Question lent itself to a “tick box” mark. My marking sheet. Candidate number Title Ketamine sedation in ED

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SAQ 7

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  1. SAQ 7 Write a protocol for the use of ketamine for procedural sedation in the emergency department (100%)

  2. Question • Core knowledge • Wide range of level of answers • Question lent itself to a “tick box” mark

  3. My marking sheet • Candidate number • Title Ketamine sedation in ED • Purpose Safety around ketamine sedation • Target audienceDoctors, nurses, pharmacists • BackgroundKetamine dissociative anaesthetic/analgesic/sedative/maintains airway reflexes with appropriate dose

  4. My marking sheet continued ….. • Indications - short painful procedure/other simple method egdistraction N20 are inadequate, best performed in ED • Contraindications- ages eg <1 >65, fast, raise IOP/ICP, anaesthetic risk, allergy, seizure, mouth procedure, URTI, pregnant, ADHD, IHD, extra info • Side effects, Nystagmus, tachycardia, HT, Laryngospasm, Emergence, vomit, apnoea in big fast dose, ways to combat SE

  5. My marking sheet continued ….. • Preprocedure /proc/post procedure • Consent – verbal, written, alternatives, info sheet • Staffing - 2 doctors/nurses - roles/ level of experience/accreditation • Environment/equip– resuscitation or equivalent. Airway adjuncts • Preparation of patient - monitoring – specific, Vitals n, IV access, calm environment, O2, methods to prevent emergence eg quiet • Drugs – ketamine/atropine/ondansetron/midazolam • Ketamine Dosing/speed/amount/route/ redosing endpoint/maximum/preparation • Documentation • Post procedure – observation, back to pre procedure, eat drink, walk, advice, staffing • Discharge instructions- follow up, driving, with responsible person • Author and review date Key aligned documents, reference • Mistakes with important facts inadequate staff, big dose, whole section missed

  6. Best answers . . . • Most ticks! • Read like a complete protocol that you would find on work intranet • Included clinical and non clinical details • Detailed • Ensured safe practice - process start to finish, accredited staff, correct patient selection, detailed instructions on dosing etc • Without major mistakes

  7. Potential Improvements …. Common Not enough on the paper • large areas missed, • not enough detail to make safe eg dose qualifications Less common Not familiar with ketamine Wasting time on not answering question

  8. In summary. . . • Straight forward question • Answer the question • Include detail • Well done and good luck !

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