The issue for npo status for conscious sedation came up a few times over the weekend. The general recommendations are attached.
If the patient just ate, you canNOT do conscious sedation. The risk of aspiration is great, and the patient may choke to death.
If it’s a non-emergent procedure (like a hip dislocation), the patient has to wait, or try alternative modes of anesthesia (e.g. joint injection, nerve block, brutaine).
If it’s an emergent procedure (active GI bleed, dislocation with vascular compromise), then the patient has to be intubated, either in the ED or in the OR.
If you see me in the ER, ask me about my boo-boo and the near-disaster.
I know Siuf does not actually believe what he just wrote…
Those recommendations are the Anesthesiology recommendations – from 2002. More consensus than evidence…
ACEP Guidelines are not as hardcore – stating that having recently eaten is NOT a contraindication to PSA. Taking into account triage time + intern time + pre-attending time + … what ED patient hasn’t waited at least 2+ hours before PSA anyway???
I’ve had the “privilege” of reviewing all of the ED’s PSAs for the previous 18 months, have not seen any aspiration complications…